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; ♦T; ♦TI� ♦fr' 'XPi '�fr. ♦fr' ♦Pi ♦fi ♦li ♦+; ♦}I' ♦Ti �}% 1fr <br /> !11. .111. .N1. .111. .�1�. !11. .111. 7 111... ./+1. !11. ./+1. .1+1 .�1�.. .11�.. !1�. .��1. <br /> CERTIFICATE .i. <br /> OAF INSTALLATION <br /> FOR THE <br /> PLASTEEL° ELUTRON° UNDERGROUND <br /> TANK ; <br /> In compliance with part 280 of Title 40 of the Code of ELUTRON° TANK DATA <br /> }r' Federal Regulations,this document may be implemented to <br /> meet Subpart B, paragraph 2:80.2(e), CERTIFICATION OF The U.L.Label and serial number is on the top centerline of the <br /> INSTALLATION, tank and also listed on the delivery document <br /> The installer must initial all sections below representing SIZE IN GALLONS U.L.SERIAL NUMBER sT: <br /> i . <br /> that the installer has read, was cognizant of and has com- <br /> pleted, as applicable, all sections of the PLASTEEL° <br /> ELUTRON`' Tank Installation Instructions attached hereto. -IT; <br /> +1. Return completed form to manufacturer to activate 111, <br /> warranty. <br /> —T— <br /> '+1. INSTALLATION CHECK—OFF <br /> COMPLETION LIST INSTALLATION COMPANY <br /> SECTION INITIAL DATE <br /> I. GENERAL NAME <br /> -t' 31. VISUAL INSPECTION <br /> dic - — Mi1 <br /> ill. HANDLING ADDRESS <br /> IV. EXCAVATION DEPTH, BEDDING AND BACKFILL _ —- <br /> +1' V.ANCHORING SYSTEMS CITY,STATE,ZIP <br /> VI. TESTING <br /> TELEPHONE <br /> ♦f, «}I <br /> VII. VENTING:JACKETED <br /> VIII. PLASTEEL" SEALING PROCEDURES INSTALLATION COMPLETIONISUPERVISOR'S SIGNATURE <br /> INSTALLATION DESCRIPTION The responsible supervisor's signature below represents Yy <br /> +` that phases I through VIII were properly completed per the <br /> INSTALLATION SITE PLASTEELt ELUTRON° Installation Instructions: <br /> '._y <br /> . f , <br /> ADDRESS SIGNATURE DATE <br /> CITY,STATE,ZIP - - PRINT NAME - .7P . <br /> . lcl. <br /> 1f' PLASTEEL"• TANK OWNER YOUR PLASTEEL`' TANK MANUFACTURER IS: <br /> F,_971 `fI <br /> NAME �' ----- -- -_ <br /> NAME <br /> F11. ADDRESS ADDRESS iii... <br /> CITY,STATE,ZIP CITY,STATE,ZIP �4 Ffi <br /> SIGNATURE DATE TELEPHONE <br /> .`f7. I <br /> '1`• RETURNS COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY <br /> FORM 4NS1 CERT-1193E <br /> �f, 1Ti _♦Ti_ �Tr' 1Tr' .•fi _♦Tr` I 1}, LTi 1L ♦fi �T,' ♦b' �f-- �}y .moi+. .�I_. <br /> !+1. .111.' .111. .1+1. .ii% 11♦ /y1 /1 , <br />