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To: Page 5 of 10 2015-12-01 00:49:17(GMT) 14153999602 From: Nikola ZAGOROV <br /> REG VEU <br /> UST SYSTEM RETROFIT OR REPAIR NOV 3 0 2015 <br /> (Submit mininfurn of 3 sets of plans&applications:as originals will be retained by EHD) <br /> t•.. Site map enclosed? YES NO it ENVIRONMENTAL <br /> HPAITH ncoAaTRAGKIT <br /> 2. Submit copies of ILC Service Technician and/or Installer's certificate antl 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 ion th a jobsite as required by Title 8- <br /> 3. 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/or replacements. If repairing a component,describe how.this will be done. (if <br /> addinq piping; UDC's,or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timety plan review): <br /> �, t�ti1c,Q i:1m K- t_A\C_ " - - -:For- e»QZ1R <br /> 4. List of equipment.to be.used(Attach manufacturer's specification sheets showing thin!-party approval): <br /> t+-c t- —_r) <br /> !& <br /> 3 <br />