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r7l',',r----',,7111�'4'�*V'!i', <br /> ...; _ "`,.. `G`k "`!y "}1S+""PR�rr*►PgR .as: .- ;cm r..-+;e..�. ....,.�,.,,,..-..�.... n,. r nr a- - x*,a. ,r r. r_x:, ,�,. _ <br /> INSTRUCTIONS FOR COLLETING FORM "C": TANK INSTALLATI N CERTIFICATION <br /> GENERAL INSTRUCTIONS <br /> 1. Each tank system must be In compliance with the federal and state technical <br /> standards, contained in law and regulations, for tank and piping installation. <br /> 2. This certification shall be completed by either the UST owner or representative. <br /> 3. One certification is required for each tank system. This form shall be used to <br /> make the required certification. <br /> 4. Please type or print clearly all requested information (for printing, please use a <br /> hard point writing instrument). <br /> 5. Submit the completed certification to the appropriate Local Implementing Agency. <br /> 1, INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE <br /> INSTALLATION REQUIREMENTS .ARE MET. <br /> I1. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE <br /> CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND <br /> CORRECT, THE PERSON'S NAME SHOULD BE PRINTED UNDER THE <br /> k SIGNATURE. <br /> i <br /> • <br /> 4 <br />