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UNIFIED PROGRAM CONSOLIDATED FO <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> CERTIFICATE OF COMPLIANCE (one page per tank) <br /> Page 2 of 2 <br /> I.FACILITY IDENTIFICATION <br /> BUSINESS NAME(same a4 FAca1TY NAS or nen-ndag nwlness M) a <br /> Chevron Station#210997 <br /> ADDRESS(For Iwel we only) 476 <br /> Hwy 99&Colony Drive,Ripon CA 95366 <br /> FACILITY ID# 1 TANK ID# 4n <br /> 0 0 0 0 0 0 0 0 0 0 0 2 Supreme Unleaded <br /> 11.INSTALLATION <br /> (Check all that apply) <br /> 418 <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 479 <br /> with underground storage tank installations. <br /> 480 <br /> ® The installation has been inspected and approved by the Unified Program Agency. <br /> 481 <br /> ® All work listed on the manufacturer's installation checklist has been completed. <br /> 482 <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 483 <br /> voluntary consensus standards and written manufacturer's installation procedures. <br /> Description of work being certified: <br /> NEW STATION CONSTRUCTION TARGET INSTALL 7/1/02 <br /> M. TANK OWNERIAGENT SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF TANK OWNER/AGENT DATE 484 <br /> D.R.LERI 4/16/02 <br /> NAME OF TANK OWNER/AGENT(print) 485 TITLE OF TANK OWNERIAGENT 486 <br /> Chevron Products Company/Geoff Vogel Project Engineer <br /> UPCF(1/99 revised) 178 Formerly SWRCB Form C <br />