Laserfiche WebLink
Dec 10 13 08:47a <br />SA -it to y `I <br />141t,//3 <br />Elit- IV Contactors <br />�, /J�,� tv�cfllTl,Y' <br />12094616342 <br />p.l <br />RECEIVED <br />�,DEC 1 0 2013 <br />of C ✓ . L L 1010.jh4vs-T SYSTEM RETROFIT OR-REF11 IR <br />(Submit minimum of 3 sets of plans& applications as originals wit 't retained by EHHEALTH DEPARTMENT <br />� <br />_ 1. Site map enclosed? .. YES_V---. -. - NO( <br />2. Submit copies of ICC Service, Technician and/or Installers certificate and all mE n lacturer training certificates for each <br />person,.tnstalling..or-tettng..any component that Is repaired orreplaced. Ensure: i copy of the "Site Health and Safety <br />Plan" Is. available.on thejobsite.as. required by Tlfie 8. <br />3. Detailed description of work to.be completed.- List components to, be repaired cr r placed and attach a diagram drawn <br />to scale shbwing'locatlon of repairs and/or replacements. If rapairing a compon:r .,describe, how this will 'be done: (If <br />adding piping, UDCs, or other UST-equipmeni, or performing tank top upgrada=, ise the UST Installation Appllcatfon <br />pages 48 as necessary f a timely plan review): <br />Uic'c:� C <br />e I r . ., fl <br />. ..I .1''1. . <br />#- l <br />gin/ <br />1 <br />► 7 i .z��L� �i,�',. <br />4. Ust of equipment to be use`" � tAttach manUjacturer's specification sheets showing thin parry approval): <br />... ; - <br />J <br />