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Dec..22 09 12:21p Elit V Contactors 120946 42 <br />UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed? YES NO[] <br />P•3 04 <br />2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer 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 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 />rig <br />111,111ilil 119DRAWWWWW" 14NOWAN <br />1■ � � �r� tr ,� " _r it 1 1 .� ,. <br />l � l <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third -party approval): <br />) - r Pck f & sched 10 a 51,Y -fOL tkS <br />UNW- 1 ,, <br />2 <br />