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r <br /> 4 <br /> ♦fi \Ti \Ti \fi \Te' \fi 7 ♦fi ♦ti \Ti '\Ti Ti ♦Ti \ti \b` \f1 <br /> -N. . !1�., , , r <br /> =!� <br /> CERTIFICATE <br /> OF INSTALLATION <br /> C <br /> FOR THE <br /> P LAST E E L° o <br /> -- ELUTR�N UNDERGROUND <br /> +�: TANK <br /> 19 <br /> In compliance with part 280 of Title 40 of the Code of ELUTRON' TANK DATA 19 <br /> Federal Regulations,this document may be implemented to <br /> meet Subpart I3, paragraph 280.2(e), CERTIFICATION OF The U.L. Label and serial number is on the top centerline of the [2 <br /> INSTALLATION. tank and also listed an the delivery document. <br /> ♦!i The installer must initial all sections below representing SIZE IN GALLONS U.L.SERIAL NUMBER <br /> that the installer has read, was cognizant of and has com- L <br /> B <br /> pleted, as applicable, all sections of the PLASTEEL` <br /> «li ELUTRON" Tank Installation Instructions attached hereto. <br /> Return completed form to manufacturer to activate i L� <br /> warranty. <br /> INSTALLATION CHECK-DFP R <br /> --- — <br /> COMPLETION LIST INSTALLATION COMPANY R <br /> SECTION INITIAL DATE <br /> Er <br /> L GENERAL NAME r[ <br /> II. VISUAL INSPECTION — C <br /> III. HANDLING ADDRESS <br /> .Fty IV. EXCAVATION DEPTH, BEDDING AND BACKFILL —_`` ` <br /> C <br /> V.ANCHORING SYSTEMS CITY,STATE,ZIP <br /> VI.TESTING I } _ L` <br /> TELEPHONE <br /> =!° VII. VENTING: JACKETED <br /> INSTALLATION COMPLETION/SUPERVISOR'S SIGNATURE L <br /> VIII. PLASTEEL" SEALING PROCEDURES C <br /> F%61-71 INSTALLATION DESCRIPTION The responsible supervisor's signature below represents C <br /> I_1;ZI that phases I through VIII were properly completed per the E <br /> INSTALLATION SITE PLASTEEL'"' ELUTRONI' Installation Instructions: C <br /> C <br /> +` ADDRESS SIGNATURE — DATE r <br /> \T� <br /> Ec <br /> CITY,STATE.ZIP - PRINT NAME <br /> t: <br /> PLASTEEL", TANK OWNER YOUR PLASTEEL2 TANK MANUFACTURER IS: <br /> C <br /> \fi <br /> NAME NAME <br /> L: <br /> ADDRESS ADDRESS <br /> CITY,STATE,ZIP CITY,STATE.ZIP <br /> SIGNATURE DATE TELEPHONE — C <br /> F Ti <br /> RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY C <br /> FORM INST CERT-1193E Ei <br /> r. <br />