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Dec 17 10 02:13p Elite TV Contactors 12094615342 P.1 <br />,Ti"2CJf 0�1 91Y -J <br />YSTEAA'l REE <br />I ROFIT OR R'r-_PAiR <br />r, U S <br />40" 'p (Submit minimum of 3 sets of plans & applications as originals will be r$taiped by. EHP) <br />1. Site map enclosed? YES N041 <br />2. Submit co ie s of (CC Service..Teciinici2n- and/or Instailers certificate an <br />p - manufacturer tra fies for <br />' <br />each- person- installing- or testing-.any-7;omponertt-that-is-repaired. or replaced. L -o Ensure a coe <br />.y e 3&Xealth <br />and Safety Plan" is available on the jobsite as required. by Title 8. <br />N <br />3. Detailed description of work to be completed. List components to be repaired or � <br />, <br />reptaced644'� "$6 <br />')�a 9FaM <br />drawn to scale showing location of repairs and/or replacements. If repairing a component, �d1166 how this will <br />be done- (If adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST <br />Installation Application pages 4-8 as necessary for a timely plan review): <br />i�� <br />(fir l � I,, <br />/}, + j ��.�� /� �� <br />UKN "81TAT' �IZAWJM <br />:11 <br />4"'eEFAtion sh�i&(skawinngd;f ird-party approval): <br />Lilt yi A� u6W rAttach'moaruMciii <br />nnv- CAY-) M `tel R) 'M �- In r*ni(' V-)14 <br />DEF I. I b be-nd V! 11 <br />� (VLo V�A acnvht�� I <br />3 <br />IV, <br />