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09/04/2007 15: 38 7076733111 ALPHA PETROLEUM PAGE 02/03 <br /> UNII'iEd PROGRAM GO OLIDATED FORM TANKS <br /> =UM <br /> ofDERGROUND STORAGE TANKS -INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> (on°peg`parca <br /> Page_ of <br /> I.FACILITY IDENTIFICATION <br /> 3 <br /> BUSINESS NAME.(flame v FACiLCiY NAME m DBA—odng Buainess A7) <br /> L D(/j5�5 -7',�R��v �,r1 � 476 <br /> ADDRESS(For load 00 WY) <br /> 4" <br /> FACILITYTDH :ELLLU T71 I- I i I TANK ID41 <br /> IT.INSTALLATION <br /> (Check all that apply) <br /> 418 <br /> j� The installer has been txained and certified by the tank and piping manufacturers, <br /> The installation has been inspected and certified by a registered professional engineer having education and experience <br /> with underground storage tank installations. 480 <br /> The installation has been inspected and approved by the Unified Program Agency_ <br /> 481 <br /> All work listed on the manufacturer's installation checklist has been completed. <br /> 482 <br /> Z The installer has been certified or licensed by the Contractors' State License Board. <br /> The underground storage tank,any primary piping,and secondary containment was installed according to applicable 4as <br /> voluntary consensus standards and written manufacturer's installation procedures. <br /> Description of work being certified_ 3 <br /> 4� <br /> III, TANK OWNER/AGENT SIGNATURE <br /> i certify that the information provided herein is true and accurate to the best of my knowledge. <br /> 434 <br /> SIGNATURE OF TANK OWNERIAGFNT <br /> DATE —zl—® <br /> 9 us TITLE OF TANK OWNERIAGENT 485 <br /> NAME OF TANK OWNER/AGENT(print) <br /> X x <br /> UPCF(1/99 revised) 14 Formerly SWRCB Form C <br />