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Apr 14 11 08: 59a Elite IV Contactors 12094616342 p. 2 <br /> T <br /> M. <br /> - 1 EPA <br /> 'U"ST SYSTEM RE RO1FiT ic <br /> OR Rro r <br /> (Submit minimum of 3 sets of plans&applications as originals will 31 :--etained by EHD) <br /> 1. Site map enclosed? YES [I NO[] <br /> ............. ------- <br /> e e Technician.and/or In' certificates for <br /> 2. Submit copies of JCC S rvic ihcia <br /> -** --*'-- -' stalle s-certificate and ail in nufacturer training cer <br /> each.person,installing or testing.any component that is.repaired or replaced. insure a copy of the "Site Health <br /> and Safety Plan"is available on the jobsite as required by Title 8.. <br /> 3. Detailed description of work to be completed. List components to be repalmd x replaced and attach a diagram <br /> drawn to scale showing location of repairs and/or replacements. If repairing a -omponent, describe how this will <br /> be done. (if adding � a a <br /> piping, UDC's, or other. UST equipment, or performing n ':ink top upgrade, use the UST <br /> Installation Application pages 4-8 as necessary for a timely plan review): <br /> I It I/ <br /> C,21 <br /> b&ot 61 &A <br /> A"ft(j,11,jii-- Inco, -Ltn z <br /> f <br /> a-ad kid" aalw 4L *qnd Lad' <br /> '0, U <br /> 4. List of equipment to be used(Attach manufacturer's specification sheets showil i third-party approval): <br /> )�h A,1 rA it 03 <br /> klea IV <br /> 9! rA-19 QLZ/za . <br /> o <br /> 3 <br />