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Oct 29 14 03: 05p Elite•IV Contactors 12094642RECE�VED <br /> UST SYSTEM RETROFIT OR RE:F AIR OCT 2 9 2014 <br /> (Submit minimum of 3 sets of plans&applications as originals wi be retained by EHD) <br /> 1. Site map enclosed? YES [ No[] ENViRONIVIEENTAL HEALTH <br /> DEPARTMENT <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all T inufacturer training certificates for each <br /> person installing or testing any component that is repaired or replaced. Ensu : a copy of the `Site Health and Safety <br /> 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 r replaced and attach a diagram drawn <br /> to scale showing location of repairs andfor replacements. If repairing a compi: lent, describe how this will be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgra e, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> p I Lr x i A 4-&n ii, Ilz e'er.. <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets sho+wi ,q third-party approval): <br /> t�eal�ee�� ; �1 A(� Y��.: �'�n�ol tter� _ ��� �� � •i c n1� <br /> 3 <br />