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Oct 25 10 01:41p Elite IV Contactors 12094616342 p.l <br />Is <br />Sk <br />s <br />UST SYSTEM RETROFIT OR REPAIR <br />'Submit minimum of 3 sets of plans & applications as originals will be retained by EQ 52010 <br />1. Site map enclosed? 'YES[] NO [ ] <br />2. Submit copies of ICC. Service Technician andlor Installer's certificate and all manufacturer training 6 'i1:i6" (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 to be completed. List components to be repaired or replaced and attach a diagram drawn <br />to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br />adding piping, UDC's,or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary for a timely plan review): <br />I i1staI 14'e CA cK- (Z cot 1S17 — <br />4.; <br />-=R_t4l a si Si+e`J e Xf sthi'L 1%��Cf f:V 'i�-L:G'� . I l�S _��A �J_"_ _ -::f. .Vl(duee <br />cam{ theVll CCO <br />R,n1,)C•Vi�— fka___ldre t—. -tensor CLr G41 ---r ?i ae-1' <br />l n5tit.� ! �w¢, � t-l-� V��r- t2ec.T' ��s�r�_ •r � z�s�-h v�. Shur d:: �:n � -- <br />I''1 ayyl rXI, �l <br />List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />_1 �-e-edcr- l2oo-�-� f�lr�lp GC)q- SOVI h�y4-rp_ tl- Mc&,ie, <br />4- - Veeeier- 14Ct _ 5300 40 536 Erwa6) ..0,. VST VO -20C Flo,; i Jenscnr <br />Ir <br />