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Oct, 24 13 09: 47a Elite _IV Contactors 12094616342 p. 2 <br /> RECEIv <br /> E® <br /> MclurA 5F1 kt- 00caoN , OCT 24 2013 <br /> UST SYSTEM RETROFIT OR REP.A R ENVIRONMENTAL <br /> (Submit minimum of 3 sets of plans&applications as originals will b retained b� T'H DEPARTMENT <br /> 1. Site map enclosed? YES[] NO[] <br /> 2. Submit copies of 1CC Service,Technician and/or.Installer's.�rdliicate and all ma it 'acturer.training certificates for each <br /> person installing or testing any component that is repaired or replaced. Ensure E copy of the"Site Health and Safety <br /> Plan".Is availableon the jobsite.as.required by Tile 8. <br /> 3. Detailed description of work to.be completed. List components to be repaired o., r• placed and attach a diagram drawn <br /> to scale shbwing location of repairs and/or replacements. If repairing a componer describe how this will be done: (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgradE, :se the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> it . c-unhin o -A Inceo <br /> ayrci�(rrk (�-SwLhc TU 2o <br /> C 0 <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showing ti,it -party approval): <br /> � I OTAT) <br /> , <br /> 1AIl �--:. ♦ 1 .�.y rIR 1� # ! ♦+t1,.♦j1�iYl 1.r♦' # <br /> 1 •, !/ /1 i / t . 1 11 ♦V SIR ♦•t RI♦ !♦ 11 1 l ,1• Y + ♦ . �i♦. I�t'127 {.`7.#/f1 ♦ , 11 <br />