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Nov 21 14 02:38p Elite Iv Contractors Inc 20846 942 p.6 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 Wft of plans & appkations as originals will be retained by EHD) <br />I _ Site map enclosed? : YES [ ] NOY', <br />2. Submit copies of IGC Service Technician andlor Installer's c effd1cato and all manutac har-r training certificates for each <br />person installing or testing any component that is repaired or replaced- Ensure 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 W be completed. List comports to be repaired or <br />replaced and attach a diagratr, drawn <br />to scale shovvirg location of repairs and/or replacements. if repairing a componerit describe how this will be done.. (If <br />2�� piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 48 as necessary for a timely plain review): <br />i IJ r It rr I P j C IN <br />4. List of equipment. to be used (Attach manufacturers specification sheers show" third -party approval): <br />ICA C + <br />NOV 2 12014 <br />l NVIRONM Ir 1 r _ <br />DEPARTr�ALl H <br />MENT <br />3 <br />