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0 <br /> INSTRUCTIONS FOR COMPLETING FORM "C": TANK INSTALLATION CERTIFICATION <br /> GENERAL IntITTRU TI N <br /> c Vr��k system, rrrrir t I, in compliance I h the federal and state technical <br /> c ontairi d in law and regulations, for teak and piping installation. <br /> , T Ir; certification shall f a completed by either the UST owner or representative. <br /> , Darr certification is rept Ir d for eacn teak system. This form shall be used to <br /> make the required rtiw c tion, <br /> 4, 1Azgse, type or print dearly all requested information (for printing, please use <br /> x„rtJoint writinq in trurnent) <br /> y sir I r lr rr' e ,l _c tion t3°d the appropriate Local Implementing Agency, <br /> I. N55"All-I.Ar,T10ISI: MARK ALL OF HE ITEMS THAT PPL TO INDICATE THAT THE <br /> INSTALLATION REQUIREMENTS ARE MET, <br /> II0 A'f r: " 'I w, r 'rl ltt, °VfNER (),tl AGENT SHALL CERTIFY, l B THE <br /> MZ sly I"HA t - ty INFORMATION PROVIDED IS TRUE AND <br /> THE PERSON'S NAME SHOULD BE PRINTED UNDER THE <br /> I ��. <br /> aln <br />