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INSTRUCTIONS FOR COMPLETING FORM "C"- TANK INSTALLATION CERTIFICATION <br /> This form is required for piping replacements, but not piping repairs. <br /> GENERAL NERAL INSTRUCTIONS <br /> 1, Each tank system must be in c;otnpiiance with the federal and state technical standards, <br /> contained in law and regulations, for tank and piping installation. <br /> . This certification shall be completed by either the LIST owner or representative. <br /> 3. One certification is required for each tank system This form shall be used to make the <br /> required certification. <br /> 4. Please type or print clearly all requests i fofrnation-(far printing,-please use a-ha-rd point <br /> writing instrument , <br /> . Submit the completed cer ification to the appropriate Local Implementing Agency. <br /> t. INSTALLATION- MARK ALL OF THE ITEMS THAT APPLE TO INDICATE T .AT THE <br /> INSTALLATION 3I REQUIREMENTS TS ARE MET. <br /> IL {BATH. THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, <br /> THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. THE PERSON'S <br /> NAME SHOULD BE PRINTED UNDER ER THE SIGNATURE. <br /> INSTRUCTION FOR THE LOCAL AGENCIES <br /> The county and Jurisdiction numbers are predetermined and can be obtained by calling the <br /> State Board (916) 227-4303. The facility number may be assigned by the local agency; <br /> however, this number must be numerical and cannot contain any alphabetical characters. <br /> If the local agency prefers the State Board to assign the facility number, please leave it blank. <br /> It is the responsibility of the local agency that inspects the facility to verify the accuracy of the <br /> information, The local agency is responsible for the completion of the "local agency use only" <br /> information box. The local agency should retains the original and yellow copies. The pink <br /> copy should be retained by the tank owner, <br />