Laserfiche WebLink
Nov , 14. 2008 3 : 55PM LC SERVICES No - 5217 P . 3 <br /> IFIED POGRAMCONSOLMATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS—INSTALLATION <br /> CERTIFICATE OFCO11"LLLNCE .one .pnroJ:• <br /> P" <br /> I. FACUUTX IDENTIFICATION <br /> BtTSINESs MWEiS--Pwl'AR VASAEaDaA-Dougae+a.++A+l ,. <br /> 1 <br /> ?.L1ARF55 <br /> q�'33o <br /> M INSTALLATION <br /> (Chnk atl that appk) <br /> CryThe installer has been trained and certified by the tank and piping manufacturers. <br /> 91/ The installation has been inspected and certified by a registered professional engineer having education and experience <br /> with underground storage tank installations. <br /> wro <br /> The installation has been inspected and approved by the Unified Prog an Agency. <br /> �) <br /> All work listed on the manufacturer's installation checklist has been completed <br /> J/The installer has been certified or licensed by the Contractors' State License Board. <br /> (y The underground storage tank,any primary piping,and secondary containment was installed according to applicable <br /> voluataty consensus standards and written manufacturer's installation procedures. <br /> Description of work being certified: <br /> HL TANK OWNER/AGENTSIGNATURE <br /> I oatifY that the WbmAtiou Provided herein is tnu and Aw to to the beat of my knowledge, <br /> SIGN.a7t'RE F T. OACNER AGENT <br /> NAbm OF LAM CANNER AGENT(print) ` TITLE OF TANK QWNEIt AUENT tar. <br /> UPCF(1/99 revised) 14 Formerly SWRCB Form C <br />