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Jul 13 10 08: 58a Elite 7V Contactors 12094616342 P. 1 <br /> logo <br /> y - U! IFIED pROGRAM.C6XSOL1DATED FORM <br /> I)T�'DERGROUND STORAGE TANK <br /> CERTMCATION OF 1NSTALLA ION I MODMCA'l TON <br /> 107 <br /> - (One folmperproji:d) .-, <br /> 101 <br /> 141 <br /> - 9-�3.�r - <br /> FACE:IIYID#(Agmry <br /> . .. 3. <br /> ' BUSIIJFS�NAh4E(Scone at F<ua7'Nmffi ar Bd�JpDoingBaa�I-s/dr)l/,1 . <br /> i"�l�e4sse �,,. <br /> a . <br /> a a <br /> �. F �~4� WORKAiJTHORIZvD❑NDER PELUdL[ <br /> ',TYPE OF PROJECT(ChaJ."aJlrhm mvhA '- <br /> j] I.TANS AISIALra'OON OR REPLACEbIDvT .- (Number aDffic). <br /> ❑ 2 PIPINGINSI'ALLAIION ORMEMACEA4ENNi' <br /> E3.3.SEW INSTALLATION ORREPLA'CEtv1ENT <br /> . -❑ 4.LTMERDISPY7:L=CONTAJ4MM4TINSTALLATItIN ORREPL'ACQ�IDdl' - <br /> .. .. <br /> 04HFA <br /> _ �FS7CR2=NAFA'A - GCERTIAIF9' <br /> {t1�lYG� ��f10 `$ tIY: lteV lrr tt���tc�4 rICtU'G�YaU. .l�lcGllc r �YILi 1 C <br /> n {,, <br /> etcal; . <br /> LC <br /> >C1pcfl�irl Ctlt lJ1�G f J .. Zt✓G�JIi' <br /> G� €r?1��i . ;Z; d <br /> - <br /> Wh �- n <br /> C/ <br /> NAAffi O CONTRACTOR WHO PERFORiv1El)INSIALLATION!.�.DIFICATIONM ' - - '� <br /> . <m. 1CCt31tT7F7CATlONf Ora, <br /> CON7FACIOR LiC�E,#. <br /> . .st ?m_.. �w.._..y_.�....�,,..a«,`..;,.,.�..;.x_ S:vn_ ,w s <br /> M. ,. <br /> I certify that the inforumaion provided herein is.ttve.accvrate,and that the following conditions have been rntis6ed: <br /> ... - The inshallerhasmet'thcr5guirements set forth.ia?3 CCR¢27.15 sabdlvision3(gJ aad'(h} <br /> .: The �mdergpand.storae.,..tank, any pnm y.pipfii& md.any secondaiy'eontai®ent was mF�� according to appliea6le . <br /> _..-:vohul a y conscrosasstandards-imdmy mamtfachira's write='h t atimaat'Coctions.- <br /> ' i. ...All work li7md in the maaufacnaer's-.installation the ldist has been i.compleoeC. . <br /> , The itistalIatioa:has been inspected and approved;by the Socal.an`�ency,or f'tsga¢ed by the local agency.inspec4-d and cifiified <br /> a ie istered aroflssional engineer ha i educatim and exDmentx with uodri' undstorage tank system-mslallations. .: <br /> StGT1A OFT.4NS OWI9R OR OWNFR'S.AGENiDATE 411 PHONE 4n . <br /> )14 <br /> et- <br /> WJE E OFCERTMMIS ENW OYER(DBA) '. : :..,CEB$VFM S RM AnONSHtP 76TAIMPWIIM <br /> 1.17tt'iQCOJV1'M da TAN&OPERATOA <br /> �11gG <br /> VC , <br /> 141 S n 3 L�iTRAL1DA, . O 5•P80PIItTY owNLA <br /> lrtc,. <br /> f.. .. - s.tT18P1C7.U7ifOR2Z®t�CPNT OF ANK OWIMR: . . . <br />