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Jul 14 10 12:51p l_jt.e IV Contactors 12094616342 P.1 <br />Asx `n <br />JUL 14 2010 <br />UST SYSTEM RETROFIT OR REPAIR <br />W ° ' <br />?es - <br />1 minimum of 3 sets of plans & applications as originals will be retained by EHD) <br />1. SrF ffir.p` Lricfose' ? T YES [ ] NO[] <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 <br />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 />Q <br />4. List ofequipment..to be used (Attach <br />manufacturer's specification sheets <br />/p�showing third -party approval):U22�_er Prx* 3 1 WIUA- Wf ISD S&6On2 (-nirnne <br />WA <br />