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DEQ:-12-2006 04:34P FROM:MVP PETROLEUM ENGINE 916 984 -1117 :19259790467 P.3 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> ERGO STQ GI TAN —INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> Rade.,,.._of <br /> L FACILITY MEMpICATION <br /> 8u NAMt?[sarr rrYwaMarRAA-off b) <br /> ADD (ierioaisssa� <br /> FACtLt7'y ��, �C� <br /> T <br /> T10N,' <br /> (AMsk s)1 dun appy) <br /> Tho imWler hes been WWI arta mtifW by the tank end piping mmu&mrers. "x <br /> E3 nO with and Ration hes been in and mofied by a registtered prof conal engineer having .�. <br /> erVound storage tank instillations. <br /> Tho instailodcm has been inillmoted and approved by the unined Program Agency, ea <br /> All work listed on the menu& turWa installationdwMst has been Cojpleted. ai <br /> The installer has been cerfifled or licamed by the CmkutW Shft LCme Bm .a <br /> Of The undeVound amm tok, any <br /> vown lull and written uta d kmos Wou pmcedwm.isclary contig t Ted a ng to applicableDewripti1°r <br /> on of work being eextifie&. <br /> U T 1W-57Ak4-* <br /> III.TANK OWNEwAGENT SIGNATIUME <br /> t eaaity.dua <br /> an pm l&d I'min is titin and seams en the best oraw <br /> SIG A F T AGt 17 <br /> DAT <br /> N 0 AQEMP( ) -7� Z O <br /> 1� (Z— <br /> ® K ERIAt3t?NT <br /> tiP�ct�) -tn tmtwnrww <br /> e.ovt� <br />