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Iiec 07 1�0 10:02a _ Elite I V Contactors 12094616342 r` P.1 <br />GEC 0 �- <br />SAN JO QUi)� COUNrt <br />ENVIRONM-ENTAL UST SYSTEM RETROFIT OR REPAIR <br />HEALTH DEP <br />ubmif minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES [I NO [ } <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br />person installing or testing any component that is repaired or replaced. Ensure a copy of the "Site Health and Safety <br />Plan' is available on the jobsite as required by Title B. <br />1 Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br />to scale showing location of repairs and/or7eplacements. if repairing a component, describe how this will be done. -(If <br />addin piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as n es,98,ryOfor a timely plan review): <br />U6 I`_ V�Of %T <br />q1 <br />� -6 <br />I <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />2 <br />