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UNIFIED PROGRAM CONSOLIDATED FV..M <br /> �'7C <br /> uu I <br /> j SAN JOAQUIN COUNTY UNIFIED PROGRAM -TANK <br /> T I <br /> UNDERGROUND STORAGE TANKS - INSTALLATION AUG 0i <br /> 51999 <br /> I <br /> j CERTIFICATE OF COMPLIANCE ENAVI�O <br /> P �N1ePV TA (afl ,Rage p-,ank) <br /> 7 Z5 <br /> 1:FACIUTY IDENTIFICATION. <br /> BUSINE3S NAME(Same u FACIIRV NAME OBA-Dong 8ualsea ASI <br /> `21jY <br /> AOCRESS(For rue QnW <br /> / <br /> CZ <br /> [FAE---7[ UF- ' TANK 10 i <br /> G <br /> II.INSTALLATION <br /> (Check ail that apply) <br /> V The installer has been trained and certified by the tank and piping manufacturers_ <br /> i <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 he <br /> nstallations_The installation has been inspected and approved by the Unified Program Agencf. <br /> ge 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'State 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 /> I <br /> III.TANK OWNER/AGENTSIGNATURE <br /> I cw&Y Mat the inhxmaam alaMdaU hanm w no am amrar to ala aaR d my InoWOga. <br /> SIG NATURE TANK OWNER/AGENT OATE ' <br /> NAAE OFT K OAGVNT 06V MLZ-OF TANK CNMER/AGENT <br /> L Z&- C <br /> CIPAFCRMS(4/99) Fonr,"SWRCS Forts C <br />