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UNIFIED PROGRAM CONSOLIOATED F,-..M <br /> I SAN JOAQUIN COUNTY UNIFIED PROGRAM - , <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> I <br /> jCERTIFICATE OF COMPLIANCE AUG 0 5 1999 <br /> EN VluO (one page per tank) <br /> VI <br /> PERM(-T/SERVlGjj,(-,_ a — <br /> L FACIUTf. IDENTiEICATIOW <br /> 9USINE3S NAME(Sams as FAGITTV NAME w OBA-Ckwn dmnsss As) <br /> AOCRESS(For �uss/wv» <br /> ell <br /> FAC:L�TY 10 7t'. TANK 10 f <br /> ( <br /> If.INSTALLATION <br /> I <br /> (Check all that apply) <br /> The installer has been trained and certified by the tank and piping manufacturers. <br /> t <br /> The installation has been inspected and certified by a registered professional engineer having education and <br /> experience with underground storage tank installations_ <br /> / I <br /> �' The installation has been inspected and approved by the Unified Program Agency. <br /> All work listed on the manufacturer's installation checklist has been completed. <br /> i <br /> r The installer has been certified or licensed by the Contractors' Stare License Board. <br /> The underground storage tank, any primary piping, and secondary containment was installed according to <br /> applicable voluntary consensus standards and written manufacturer's installation procedures. Description of <br /> work being certified: <br /> r <br /> i <br /> Ill.TANK OWNERIAGENT SIGNATURE <br /> i <br /> I ui4h/ma[CM nformaoon oro+liCW Mlrn u vus 7q aoCa'ar ro Uis Dsa d mT ImaMWga � <br /> SIG NATURE TANK OWNER/AGENT GATE <br /> .4A4E OF;#AK OWNER/A 7 nTLc OF TANK ONMERJAGENT <br /> /-C Lezi <br /> CUPAFORMS(4/99) Formerly SWRCS Form C <br />