Laserfiche WebLink
ADec�15 06 09:30a Elite Iv Contractors Inc 2094616342 <br />P.1 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />RCD j 6,[/WED TANKS <br />UNDERGROUND STORAGE TANKS - INSTALLATION <br />CERTIFICATE OF COMPLIANCE DEC 1 5 2006 <br />(one page per tank) <br />FM»nr,._ <br />HE <br />of _ <br />I. FACILITY IDENTIFICATION " `v <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Dol Bneas As) r I .� <br />ADDRESS (Fwloae/ use only)iP <br />FACILITY ID O 1 TANK 10 A <br />�o pro i`-Qflll7�o <br />II. INSTALLATION <br />(Check all that apply) <br />The installer has been trained and certified by the tank and piping manufacturers. <br />-Ei The installation has been inspected and certified by a registered professional engineer having education and <br />experience with underground storage tank installations. <br />The installation has been inspected and approved by the Unified Program Agency. <br />All work listed on the manufacturer's installation checklist has been completed. <br />Ci The installer has been certified or licensed by the Contractors' State License Board. <br />P'� 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: y� <br />III. TANK OWNERIAGENT SIGNATURE <br />I COW that the iMorrtmtlon Provided herein i6 hue arg accurate to the best of m1' Inowleege, <br />SIGNATURE OF TANK OWNER/AGENT <br />DATE <br />N M4OFTANK'OWNER/AGENT (p") <br />TITLE OF TANK OWNERIAGENT <br />OF L/d/ j <br />a <br />/�'i�� k -7-,V <br />G7 <br />e,4,.. <br />