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Jun TO 11 01:48p Elite 1V Contactors 12094616342 p.l <br />UST SYSTEM RETROFIT OR REP,P.1 +, <br />(Summit minimum P4'4 setsf la & aCa 1" do <br />o p ns app no as onganals wall Le etained by <br />1. Site map enclosed? YES [ ] NO [ ] <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all n -.a rafacturer training cert 46;0-1 <br />each person installing or testing any component that is repaired or replaced. E rsure a copy of the "Site Huth <br />and Safety Plan" is available on the jobsite as required by Tile 8. =a:¢ <br />3. <br />Detailed description of work to be completed. List components to be repaired c replaced and attach a diagram <br />drawn to scale showing location of repairs and/or replacements. If repairing a c inponent, describe how this will <br />be done. (if adding piping, UDC's, or other UST equipment, or performing ; ink top upgrade, use the UST <br />Installation Application pages 4-8 as necessary for a timely plan review): <br />g a n )(w) <br />v e it I r t & t' Ir ii! y r h.CA <br />4. List of equipment to be use (Attacth manufacturer's specification sheefisshowing. tt rd -party -approval):-._._-.._. _ ... .. ....--.- <br />