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Sep 22 02 10:44a Elite Iv Contractors Inc 2094616342 p.2 <br />Use- SYSTEM RE7ROFIT OR REPAIR <br />(Submiif rninirnum of 2 sets of plans & app%abons as arigirsais wiU be retained by Ehp) <br />°y <br />Sde map enclosed YES 17 NO [2 <br />-72 'Man $ <br />,V spec sheets attach fr aR equipment to be iced YES [I NO [ j <br />`Q3. Descrq%on Oiwork to be cam eted <br />the UST i sta on —ad—ft PO4L UDC's, or other UST equoymt or peifarmftg tank top uA9rade� <br />lbra timely ptan re <br />V- 4. Descnipbon of equipment to be used <br />( r drnringslbf eprints as necessary)_ <br />''ff State cer#Tred or ND .: <br />5. apF,rnved. YES tI 1 t i iryiazi Dlk'it(i <br />6- Deco t urea C',`�te Ft <br />b. Jd p0h9 be d mated p fo removaJ� YES F -- \ r t �, (x , <br />c� .. C, 1j errfffycar�ac or fI )I <br />J�l.�l� <br />Address Pho <br />Name <br />CSC -----3 ' _zip---� <br />.`� - Method to be used for decor - .. <br />d. De=ibe how rkmie <br />® <br />r ana 15mmitted T <br />Hauler NwneSkKage,&Ds <br />V JN�40 <br />Add.. <br />city �.._ <br />c ( u a- Desdibe the method that will be <br />rJ Pm9e artdlQr inert be piping= <br />C_ -- b._ <br />rami <br />mahie <br />--�"' <br />�� � itanfer' am # (if hauled <br />Phone <br />" %�j 4 <br />mPipinq ®bposw <br />SiteEPA <br />!Niru@ <br />Addm= Phone73D <br />'D#. <br />('�} B. <br />c✓ " ed <br />Js Ttle S &m an independent U*d party from are cin . YES <br />NO [ J <br />9 <br />in detaak haw the sad andlar•watersan <br />14 <br />s) the piping m rwe�l be <br />{ <br />Name <br />qd Haider Regbbagm jp <br />C.b)Jf <br />dly <br />WE is not to be hPuled, desmibe what wig be done whir it: <br />.2 <br />