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Jan 03 11 11 : 58a EliteIV Contactors 12094616342 p. 2 <br /> I/Mb <br /> 0� <br /> UST SYSTIIEM RETROFIT OR REPAIR <br /> (Submit minimum of 3 sets of plans&appfieslffons as originals will be retained by EHD) <br /> 1 Site map enclosed? YES[] NO. <br /> 2. Submit copies of ICC Service Technicim.and/or Instialler's certificate and all manufacturer training certificates for <br /> each.person installing or testing any—component-that is-repaired or replaced. Ensure a copy of the"Site Health <br /> and Safety Plan"is available on the 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 <br /> drawn to scale showing location of repairs and/or replacements. If repairing a component, describe how this will <br /> be done. (if ad ing piping, UDC!s, or other..UST eqtfipment, or performing tank top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review): <br /> 1/1 el"It ilk va-16-c a <br /> .7 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing third-party approval): <br /> id <br /> fl'i-opl< I/ q <br /> it fit, <br /> Pal,, ma.i <br /> .................. <br /> A <br /> IMV W Yfil A49 k' -Z <br /> 3 <br />