Laserfiche WebLink
Apr 08 14 06: 50a Elite IV Contactors 1 209461 6342 P. 1 <br /> RECEIVED. <br /> '` UNIFIED PROGRAM CONSOLMATEI:'I :)IM <br /> UNDERGROUND STORAGE TA?1I9VP 08.2 014 <br /> CERTMCATTON OF.INSTALLATION.1 I IODMC <br /> �Qkeornt.PC='project) I� ONMENTA <br /> �a <br /> FACILFrY ID#(Agency Use only) <br /> BUS NAME <br /> (Some os F IVmne orDB.l:-DomgAofn=.4s) <br /> . BUSIIJE53STfEAAb ,• s ,ac. <br /> los. <br /> MmmTYPFOF PRQIEC7(Check alt char o�lv):.. � 7L, <br /> sk yp � <br /> CR AUMORIY.BD.UNDER PERMIT <br /> [❑ 1.TANK INST:4LLATION OR REPLACEl11V7` j (Ni rc :r or bate) <br /> []2 PI1!ING INSTALL•ATION:OR REPLACEMENT <br /> n 3:SUtvB WSTALLATION ORREPLACEMWT <br /> M-4:'.,MDERDLSPENSER-CONfAINMENTA�51AL7.AT70NOA'REPLr1C T1v1ENT <br /> oTHr xR t'rL �l1 i'fG lj ,eiz/AL . <br /> DI?SCRIpTIGNOF WORK BEING CERTIFIED: <br /> ' ��. <br /> C �.. . -4cho <br /> {k �`' - <br /> .. <br /> F IRA JrVIiO PHRFO IIVSTA LATION i MODIFICATION - pp 4$,� <br /> l <br /> CO2GYRAC TOR LICENS$# Saxe ;ICC' CATION <br /> MyY <br /> .. ... ... <br /> I certify that the uiformatiogprovided herein is tree,accurate,and'tlzat alae fon c ndi4oms have been satisfied: <br /> • Tho tnstallcrhas�et the segatr ements set fbTth'in 23•CCR§�715;subdivisions(g)arid'( <br /> The.?mdtrgrolmd storage taalc;atiy':primary P�P� dud any:secondary contaynai was installed according'to applicable <br /> voIuntary consensus standards:and any:manufsctuner°s vv ten on s <br /> - - - <br /> mstailation iaskrn� �. . <br /> All•work listed'in'the'mn nufacttaer's mstallaftoa chxkbst has been`complcted: <br /> The n15ta1lahan.has been inspected and approved liy the',Iocai agency,or if regwred l he:local agency,inspecti:d and certified <br /> a 'stered: rofessional.oa eer Navin .edac.atian and enc6mith and 'uiid tura tank• em installations. . <br /> SIGNATURE TAMC O WNER'OR OWNER'S AGENT <br /> WNER <br /> DATE, 94: 'lPHONE, 487. <br /> c AMS j. �as. :.CER s TI'ri� .'4s6. <br /> L C C ;f - <br /> *lL�M$OF?CER 7FIER'S EMPLOYER C4 FE[�i -TO TANK'OWNER • <br /> f R03Vt�BR II;2T�iiJICT�P£RAIOR <br /> .. ` NTiCACfp <br /> ,�3�O R '• ',�• ]3'i1:�PROPERTI OWNER <br /> THERAUT�iORIZ�D 'GENTOFTANKOWNER <br /> _:Vof <br /> UPCF UST-C Rev.(12/2007)-112 wwwAmidoc"rig <br /> - <br />