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Oct: 22 07 08:07a Elite Iv Contractors Inc 2094616342 p.2 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND ! R f' <br />CERTMCATE OF COMPLIANCE <br />Page ____ of` <br />L FACILITYIDENTrnCATTON <br />i NAME (Same I FACR TtYWANG m' DnA— Daus Husio As) <br />� s <br />(F -J Iweo*) <br />m# I I TTTTT <br />TANK <br />m y <br />Act, <br />JIL INSTALLATION <br />(Check an that amly) <br />a The installer has been trained and certified by the tank and piping manufacturers. <br />L1 The installation has been inspected and certified by a registered professional engineer having education and experience <br />with underground storage tank installations. <br />Q The installation has been inspected and approved by the Unified Program Agency. <br />ED' All work Iisted on the manufacturer's installation checklist has been completed. <br />EJ The installer has been certified or licensed by the Contractors' State License Board. <br />[' <br />The underground storage tank, any primary piping, and secondary containment was installed according to applicable <br />voluntary consensus standards and written manufacturer's installation procedures. <br />Description of work being certified: <br />f<,...1 .-i/Y'd/i� i�i���t ,'.W. r.F,lb •a-9 G'�"i �_°',�:i,r��'' �� h. <br />M. TANK OWNEWAGENT SIGNATURE <br />I cestify that the information provided herein is true and accurate to the bestof my knowledge. <br />SIG ATLIRE OF K O AG DATE ,r <br />KAME OF TANK OWNER/G 485. TITLE OF TANK 0 A <br />UPCF (1/99) Hwfwre-e -1/2 bttP://www.unidomorg <br />Rev. 02/16/00 <br />478. <br />479, <br />4W <br />481. <br />482. <br />483. <br />