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r . ;.r 'Ii t . 6 Fits)r c <br /> 4 MI N72 # , , r <br /> .. .�' <br /> OR A is .. ,... , i •i1.t.I ►' �. 1: <br /> r r i'-.f.f,r.+i <br /> N - 1/ <br /> i.. r r r:�.: � FYI. NI �. � v: 1< air. 1': 11 t • x <br /> �=1 pit'4 f. ilt . t i. .... <br /> '. '.:i ■ 1 ... <br /> ii <br /> ►rx .7 .t.. #tw t,�. C t=1774 <br /> r. M MT,TYR3 w. • .tet -r ■ + �. <br /> mill' <br /> I cer*that for the fkaity indicated at the top of Ns page,the individual(s)listed above will <br /> save as Designated USt '3:=1 c rt.. - Theindividual(s) conductand document Y 1 c'. <br /> fwility irmpections and annual.facility employeeftaiMmg,in accordance it California Code <br /> Regulations,fide 23,section 27 1 5(c)-(f). <br /> Furthermore, <br /> sa _ :_fi [ understand 1 Y is S I1 1 Iin compliance 'a the requirements ': o; 'r.:.. <br /> replations,and local ordiumves)applicable to mderground storage tanks. <br /> r. `. OF OWNER t ., + <br /> SIGNATURE OF TANK iii. �.�r <br /> DATE: v - OWNERISPHONEk <br /> 1 <br />