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Oct 04 13 09: 40a Elite IV Contactors 12094616342 p. l <br /> C :IV :D <br /> LNIMDPROMAM CONSOLIDATED)'C 3114 <br /> DNDERGROUNDSTORAGETANK OCT 04 2013 <br /> CERT'IF'ICATION OF INSTALLATION/'tl )DMCATTON <br /> _(oneformperprpect) .':. : NMENTAL <br /> xMx iy,w -ow.aH.'V{�a��,•,y.J���snu �4 <br /> FACUny M#(egmcy Use only) ` I NO <br /> HUSDa:-ce (Same¢tFadliryN arDBA-Doing Brsmev As) . <br /> CrI1 w. <br /> BUSI)N/IESSSfIE ADDRESS �' . . ' <br /> TkTEOFPROJECf(CSctuBrhm aontv7WOL•P. ,ill'HORIZED IINIDER PERMD' <br /> :L] 1.T.aNXDCTALLATION ORREPLACMAE?QT 'Duel:- <br /> .0 1.FIPING INSTALLATION ORREPLACE?IU NT. _ <br /> Q3.SUMP IN51'AIMATIONORREPLACEWNT - <br /> 04. DLSPENSrEFCONTAINMENTINSTALLAMONORREPf.ACEbID.'T <br /> El <br /> Am- <br /> DESCRIPTION Or WORRpBEBJO.CER.T.BiIED_ --. ,� - .. C �.L+ <br /> lI to <br /> map <br /> J. <br /> u <br /> til\xC/�_. <br /> -� , v <br /> 9i1i <br /> N OF CON�iA O ERFOat 4 ON/MODIFIC/A770N - _ <br /> 4R <br /> RLI RI ICC CERTIFICAMN i <br /> ... NTRAfY'OCENt, 6� <br /> T T i <br /> - -yaw xr:mErr r� s �A <br /> I certify that the information Provided herein is true,accurate,and that the followin,;.I RdifiDns'bave been satu5ed. . <br /> .: . The installer bas met theieguircmeuts set forth in 23 CCR§2715,.subdiv cions(g)and I)." - <br /> . .. . The rmdetg;ouud sWrage toner, any p Y..pV,,& and any secondary contamme t was installed according to applicabl <br /> ..-:.: .'...::::vohmtary consmsosstandardsa dany.mmufac=es wiitteninstallllirtion lns.CucfiOXV_ ,. . . <br /> All work listed in the manufacturer's rostaltation checLiisthas b=completed. cted and ceid5exl <br /> . Tbe.instatlation.bas,been inspected and approved by the local.ageri ,or'ifsequired b� the 166W agency,inspe <br /> a� d -rofessionalen neer ha" education and - 'ewe With un, stn esd nkO�eminstallatiluuLs. <br /> ..SIGN OF TANK OWNER OR OWNER'S AGFNr DATE <br /> `tC.p0 <br /> A/^ <br /> AM <br /> . CERT1FIDt'S NAME(P®eJ , ,�, <br /> :NAME OFTHIZER'S EMPi.OYER(DBA)' C6itTII7ER'SREI.ATIDNSI PTO.TANK OWNER . <br /> J/'f� .1] 1 TANF.'OWNER - 0"2TANK-OPERATOR . <br /> 3.CAN1]iMIY1R ❑ <br /> E AGETNTOFTERTYPNK OWIIJERRORM . <br /> .S.O.1�.A117'60RR .OFT " <br /> Vie+ ;BPCFUST-C R".(L=80)-L2 xvw.widowr^._... <br />