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05/20/2004 09:25 70744640-6 CAL INC & PAGE 07 <br />of <br />UNIFIED PROGI2,AM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS - INSTALLATION <br />CERTIFICATE OF COMPLIANCE <br />(DAeFggo pa�ctBGk) <br />Page I of I <br />I: VACILITY IOEN7 FICATION . <br />BUSINESS NAME (Smna a FACIIdtY NAME orl)33A —Doing Business As) <br />� <br />San Joaquin Coun Sheriff Motor fool <br />DR <br />ADDRESS (For Iml sere veli) <br />47ti. <br />7040 Micheal N. Catllis Blvd, Fretleh Camp'CA <br />FACILITYEW <br />�• TANK ID d# <br />w7. <br />m INs ANLL ATTION " <br />(Che:k all that apply) <br />476. <br />® The installer has been trained and certified by the tank anc. piping manufactures. <br />❑ The installation has been inspected and certified by a registered professional engineer having education and experience <br />with underground storage tank installations. <br />® The installation has been inspected and approved by the Unified Program Agency. <br />480. <br />49i. <br />® All work listed on the manufacturer's installation checklist has been completed - <br />® The installer has been certified or licensed by the Contraci ors' State ]License Board. <br />482. <br />® The underground storage tank, any primary piping, and secondary containment was installed according to applicable <br />93, <br />voluntary consensus standards and written manufacturer's installation procedures. <br />Description of work being certified: <br />Installation of dispenser secondary contianntent, re -mut of vent lines, installation of leak duction shut-off dispenser mechanisms. <br />III. TANK OWN.ER/AGENT Sif'NATURE <br />I certify that the information, provid W herein is true atid acourrate to the beat of l ny knowledge. <br />S1CrNATTIRFi OF TANK O W IaER/.AGENT <br />-'_ <br />i)ATL' <br />494• <br />NAPvIIi OH TANK OWNER/AGENT (punt 4x5. <br />8-IfItm <br />TfrLE OF TAMC OW AGENT <br />. <br />496. <br />Andrew -, <br />Pro �/xtq �- CAL X'1V <br />UPCF (1/99) Hw1Wre-e - 112 http://www,unk10e9.urg <br />Rev. 02/16/00 <br />