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VERIFICATION BY OWNER <br /> By signing below, the tank owner or his designated agent has verified that this form has been <br /> completed with all required signatures and acknowledges receipt of this affidavit. Owner should <br /> send a copy of this Affidavit to the lining material manufacturer for authentication and maintain the <br /> original signed affidavit as part of his tank records. <br /> Note: Under applicable federal law, it is the tank owners responsibility to determine that his tank <br /> meets the requirements for valid upgrade and to maintain records that demonstrate his tank is in <br /> compliance with the upgrade requirements. <br /> Date <br /> Owner or Authorized Agent Signature <br /> Page 3 of 3 <br /> 35 <br />