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Nov 06 14 04:14p Elib IV Contactors 120946342 p.4 <br />UST SYSTEM RETROFIT OR REP "SIR RECEIVED <br />(Submit minimum of 3 sets of plans & applications as originals wil be retained by EHDP V 0201 <br />1. Site map enclosed? YES[] N0 ENVI'RC}, <br />A HFA TH <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all rn: nufacturer training certificates for iia r <br />person installing or testing any component that is repaired or replaced. Ensw 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 repairer: i • replaced and attach a diagram drawn <br />to scale showing location of repairs and/or replacements. If repairing a cornpo! ent, describe how this will be done. (If <br />adding piping, UDC's, or other UST equipment, or performing tank top upgn)( use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />4. List of equipment to be used (Attach manufacturer's specification sheets sho+s/i g third -party approval): <br />ca <br />