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02/05/2004 15:31 40894201? BATCH PAGE 03 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> (one page per la <br /> Page I <br /> 1. FACILITY IDENTIFICATION <br /> nIS]NI:SS NAM I.tSanq•pI AVIIAIV unntua onA DoW9141anve,At _. <br /> Tracy Chevron <br /> 3400 McArthur Boulevard,Tracy.CA <br /> rACILrrY 100 'TANK 11)R <br /> 1- 2.11,INN)-mPon-IIS1.(87. Regular Unleaded) ; <br /> It INSTALLATION <br /> (Cheek all(hal apply) <br /> The installer has been trained and certified by the tank and piping manufacturers. <br /> ❑ The installation has been inspected and certified by a registered professional engineer having education and experience <br /> with underground storage tank installations. <br /> ® <br /> 'I he installation has been inspected and approved by the Unified Program Agency. <br /> ® All work listed on the manufacturer's installation checklist has been completed. <br /> ® The installer has been certified or licensed by the Contractors' State License Board. <br /> ® The underground storage tank, any primary piping, and secondary containment was installed according to applicable <br /> voluntary consensus standards and written manufacturer's installation procedures. <br /> Description of work being certified <br /> InMaliation of new USTs and associated piptnK. <br /> lit. TANK OWNER/AGENT SIGNATURE <br /> I vorlir)Ilwl the inli rmalion provides herein is true a1u1 accurate to the h,..t ol'mr knowlucip. <br /> SKINA'I't lltE t)t'I'AJJK t1WN1'R1.A(:I;N'I' DA 11: <br /> fin' - �• 112/pt/113 <br /> NAM(;UPt'ANK 11wN1 WAMiNr(prinl) 'I'I'19Jn)P I ANKOwNt:R/A(IFN'I ° <br /> Autumn Btaktey- ''"' <br /> Contractor <br /> Batch Petroleum Contractors& Builders.Inc. <br /> I rCt(1199)IWwre-c-]a hup://www.unidomorx Ito'.(ivill a <br />