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�Ir Ali Ali Ali di • di Ali Ali di I �Ir' L �ti Ali Ali a/i �ti <br /> ��/ nLJ /1�• �1�. !1�. !/�. I !1�. [G !1�. �1�. �1�. !1�. !1�. <br /> CERTIFICATE <br /> OF INSTALLATION <br /> FOR THE <br /> PLASTEEL® ELUTRON® <br /> UNDERGROUNDTANK <br /> NTrpl In compliance with part 280 of Title 40 of the Code of ELUTROWTANK DATA <br /> r0l,17 Federal Regulations, this document may be implemented to <br /> !1� meet Subpart B, paragraph 280.2 (e), CERTIFICATION OF The U.L.Label and serial number is on the top centerline <br /> INSTALLATION. of the tank and also listed on the delivery document. <br /> .\,A The tank owner or owner's installer must initial all sections SIZE IN GALLONS U.L.SERIAL NUMBER <br /> %;:; below representing that the installer has read, was cognizant lig. <br /> of and has completed, as applicable, all sections of the <br /> PLASTEELI,ELLITRON1'Tank Installation Instructions <br /> %IP. attached hereto. TANK INSTALLATION COMPLETION DATE <br /> Return completed and signed certificate to the manufacturer <br /> RN within 60 days of the installation completion date to activate <br /> :wi`. warranty. INSTALLATION COMPANY <br /> INSTALLATION CHECK-OFF <br /> COMPLETION LIST NAME <br /> SECTION INITIAL DATE <br /> I. GENERAL ADDRESS <br /> ;�� II. VISUAL INSPECTION F. <br /> III. HANDLING <br /> IV. EXCAVATION DEPTH,BEDDING AND BACKFILL CITY,STATE,ZIP <br /> V. ANCHORING SYSTEMS .!r. <br /> VI. TESTING <br /> TELEPHONE <br /> VII. VENTING:JACKETED <br /> VIII. PLASTEEL-SEALING PROCEDURES INSTALLATION COMPLETION/SUPERVISOR'S SIGNATURE <br /> INSTALLATION DESCRIPTION The responsible supervisor's signature below represents <br /> that phases I through VIII were properly completed per the <br /> INSTALLATION SITE PLASTEEL®ELUTRON®Installation Instructions: ice. <br /> ADDRESS SIGNATURE DATE -t- <br /> CITY,STATE,ZIP PRINT NAME <br /> `ti •=t� <br /> PLASTEEL•TANK OWNER YOUR PLASTEEL•TANK MANUFACTURER IS: 1 <br /> �!G NAME NAME =�r <br /> ADDRESS ADDRESS <br /> CITY,STATE,ZIP CITY,STATE,ZIP <br /> '.t_ ►`�_ <br /> SIGNATURE DATE TELEPHONE <br /> L91 r2J <br /> t� RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY '— <br /> . 1 . <br /> FORM INST CERT-0900E <br /> Rk <br /> ,Ir Ali Ali �ti qtr' di �►! qtr ♦trC �ti Ali Ali Ali Ali �Ir/P. /1�. /P. /1�. ./1�. /1�. '/1%. <br />