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Jul 31 14 07:12a <br />(Ite--y <br />Elitg_IV Contactors 12094616342 <br />RECEIVED <br />Iq <br />°x>��r'rRo�zr�r'corrsvr�mAT�v� Fes:=. , JU <br />UNDERGROUND STORAGE TAM,', - <br />CERTIFICATION OF .INSTALLATION /-."V 0DIFI <br />NP <br />.caa ivRNA.0 <br />(Sum asFACHnyNAbTE�6r 13A -D .gay s <br />'ESS StIEADDRESS �-t•6 <br />TYPE OF PROTECT (Check all ttutt annlvl� <br />D L TANK INSTALLATION OR REPLACEMENT <br />11.2. PIPING INSTALLATION OR REPLACEMENT <br />D 3. SUMP INSTALLATION OR REPLA(Mvff�NT <br />4, UNDER DISPENSER CONT INSTALLATION ORREPLA <br />rc5.,OITIER Jf7r' `)Pdli't � (�111f1 CEMIrZVT' <br />5io"l . <br />'r- WORT:, <br />PRZEUTJNDERPERMIT <br />(Num)c )r Date): <br />``//``yy)r��1 <br />lTt~t `1 b�SQL' 2_ O(1 SUci 9- Tc) < -iTnnS +may. <br />�Q .j04 4+hes t UyYlttu�I>)C 5Y�. SlV1Ct:J 1ccG t1L,�C3S l�i�j <br />°�� ►'��� �Q t�.x9� e-Cl5 ec! (3n 5(t�, 7ech � car, t tnS <br />htj O—OTAC!j wa—t--) 51tj -,� Wttfto-15t-ld a <br />CONTRACTOR LICENSE #! <br />TION <br />ICC CERTIFICATION # <br />_. I-certify-that•theioformation••provided-berein-is-tru -accurst <br />e, erand-that•the-following-coed ions -have -been satisfied: <br />The installer has met the requirements set forth in 23 CCR §2715, subdivisions (g) and (Ir). <br />The underground storage tank, an <br />vY prunes 1ping, and any seconnrycontainment installed according to applicable <br />o untary consensus stag an any mann aciur s carmen rnsta airoinstruckons. -- - <br />• All -.work listed in the manufacturer's installation checklist has been. completed. — - I <br />• . Tb installation has. been inspected and approved bythe local agency J <br />or if required by thy: , cal agency, inspected and certified <br />b re zstered rofessionat en ineer Navin education and a erience wit$ undergrounds L_ r: ;e l tank stem installations. <br />SIGN gF.TANK OWNER.OR OWNER'S AGENT <br />..DATE. ._ .: - •- <br />PxoNr - 487. ; <br />�1t i?cl)o t-33�1 <br />TER 5 -1 (Print) � 4as -- ' <br />CERTIFIER'S TITLE: <br />V� �C ' t <br />T��� <br />iaAM> .ox cmrl> R s F.j[bY :R (DBA) 486, I <br />au CERTTFIEit'S REr-A'I %OftP Ti )' ;NIC OWNER 489. I <br />��✓ [ 1( �C ti 1 V �U�SI �IT�� ❑ 1 TANK OWNER [j - I:A ac OPERATOR 1 <br />0 3. CONTRACTOR Cl 4 F'ROPERTY OWNER t <br />❑ S. OTFiFR AUThIORMED AGF N OFTANK OWNER I <br />Rev. (IIl2OM . <br />i <br />1 <br />H <br />