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APRT -2008 06:21PM FROM- +9255517895 T-522 P.002/002 F-134 <br /> IFIED PROGRAM CONSOLIDATED FOW <br /> UNDERGROUND STORAGE TANK <br /> CERTIFICATION OF INSTALLATION /MODIFICATION <br /> (One form per proiect) <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency I/se Only) <br /> 3. <br /> BUSINESS NAME(Stene o.s Facility Name or DBA—Doing B1,gtless As) <br /> Pacific Gas and Electric Company-Stockton Service Center <br /> BUSINESS SITE ADDRESS "13. CITY <br /> 4040 West Lane Stockton <br /> H. INSTALLATION/MODIFICATION PROJECT DESCRIPTION <br /> TYPE OF PROTECT(CLecA ell rhat nnnlvJ <br /> WORK AUTHOR12ED UNDER PERMIT <br /> ❑ 1.TANK INSTALLATION OR REPLACEMENT (Number or Dae): <br /> 0 2.PIPING INSTALLATION OR REPLACEMENT SR0053265 <br /> [:1 3.SUMP INSTALLATION OR REPLACEMENT <br /> ❑ 4.UNDER DISPENSER CONTAINMENT INSTALLATION OR REPLACEMENT <br /> ® S.OTHER 40e. <br /> DESCRIPTION OF WORK BEING CERTIFIED: <br /> Replaced the aboveground piping and spill containment for the remote used oil fill in the garage shop. <br /> III, CONTRACTOR INFORMATION <br /> NAME.OF CONTRACTOR WHO PERFORMED INSTALLATION/MODIFICATION <br /> John Sutfin-Su erior Underground Tank Service <br /> CONTRACTOR LICENSE 11 48" ICC CERTIFICATION# 4ex. <br /> 482356 A,B, C21, C27, HAZ 5254957-U1 <br /> IV. CERTIFICATION <br /> I certify that the information provided herein is true,accurate,and that the following conditions have been satisfied: <br /> • The installer has met the requirements set forth in 23 CCR§§'2715,subdivisions(g) and(h). <br /> • The underground storage Lank, any primary piping, and any secondary contaimnent was installed according to applicable <br /> voluntary consensus standards and any manufacturers written installation insnvctions. <br /> • All work listed in the manufacturer's installation checklist has been completed. <br /> • The installation has been inspected and approved by the local agency, or iFrequired by the local agency, inspected and cenilied <br /> b a registered professional engineer having education and ex enence with underground story c tank s stem installations. <br /> SIG UIiEOF ' WNER OR OWNER'S AGENT DATP. a8d PFIONE IM'i, <br /> 4/24/2008 (925) 519-7887 <br /> CERTIFIER'SNAME(pdn0 185' C6RT0ilER'S TITLE: .7 <br /> John W. Sutfin Petroleum System Contractor <br /> NAME OF CERTIFEER'S EMPLOYER(DBA) 1NX CERTIFIER'S RELATIONSHIP TO TANK OWNER dBJ. <br /> Superior Underground Tank Service dba SUTS ❑ I.TANKOWNF?R ❑ 2.TANKOPERATOR <br /> M 3.CONTRACTOR ❑ 4.PROPERTY OWNER <br /> ❑ 5.OTHER AUTHORIZED AGENT OF TANK OWNER <br /> UPCF UST-C Rev.(12/2007)-1/2 www.unidoca.nrg <br />