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ua: lbe Elite IV Contactors <br /> 12094616342 <br /> - --- _ WST_SYS P- 2 <br /> --- — _ TEM RETROFIT OR REF'tl�R_- Sp t J- <br /> (Subm(tminimum of 3 sets of plans&applications as <br /> originals wii!i ; retained by EHD) <br /> 1 1. Site map enclosed? YES[] NO[j <br /> 2: Submit copies of ICC Service Technician and/or Installers certificate and all mere lecturer training ce y fi�tes for each <br /> Parson installing or testing o any component that is repaired or replaced. Ensutr•. o of the <br /> Plan.".is available on the jobsits as required by .Title 8. - <br /> . � PY Site Healtli-and-Safety -. <br /> 3. Detailed description of work Yo be completed. List components to be re <br /> to scale showing location of repairs and/or replacements. if repairing a compomr describe how this will be done: (if <br /> adding Paged Q r Placed and attach a diagram drawn <br /> , piping, UDC's, or other UST equipment,or performing tank top upgrade, r.;e the UST Installation Application <br /> pages 4-8 as necessary for a timely Plan review): . <br /> >+ci �r )ritm"�1i a(i�UiN1�t�� 5(YR� � C� (tY1[� I lfib` IllPirrJi <br /> -�...�11.Z.L��1;�[Y1 �� � 41,f }�t� uv, ' ------�—+.is• ° MP '• , <br /> 1/l(nirri T An re furn linc-) <br /> L ( 1 t • 1. i '(KicYl <br /> nine ` 2 wjt2,r <br /> �C1r1 'f'"i�- - F'V11Yt•r'El (,Nrte ,).,- 1 A —1'.Tz, <br /> AIL i <br /> Lih a r3rl C`]r•D -•.,j1 <br /> �i Niiln a -k=�. ber5irlel�, � ' r� nefrl nmr�tn ��r� > . <br /> Na <br /> • Art A :s411�r n a 4 Y1t�, �-_;�-,�•r; %Fc,1 > � � <br /> 4n23 c,� Fnn �( nnc, n wi ► VVI 0306 r nZ0'rtQC <br /> I rrt ,_rrt5 rhe rr r. li.c , <br /> 4. List of equipment to be used(Attach manufacturer's specification she showing lhirc party approval): <br /> fit.-.. __. 4ik1dM- 7 D-UAttlf { <br /> 3 # � - <br /> X61`1 i _ <br /> _ t <br /> ,r miler v-e t lea in I,nc, U ��av�22 j <br /> • 1 <br />