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15 06 09: 30a Eli Iv Contractors Inc 2094G1 42 P. 3 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -INSTALLATION <br /> CERTIFICATE OF COMPLIANCE Z'2 <br /> (one page per taLk)jl <br /> Pao of <br /> L FACILITY IDENTIFICATION <br /> .X11 <br /> b` <br /> T-AC&MID9 Ir—F I I TAW IDO <br /> 9- <br /> IL INSTALLATION <br /> (Check aff1hat apply) <br /> 'Er-< The install"has been trained and certified by the tank and piping manufacturers. <br /> (,or/ The installation has been inspected and certified by a registered professional engineer having education and <br /> I experience with underground storage tank installalions, <br /> LUZ The installation has been inspected and approved by the Unified Program Agency. <br /> ,a,/ All work fisted on the manufacturer's installation checklist has been completed- <br /> The <br /> 0 ' installer has been certified or licensed by the Contractors'State License Board. <br /> V/ The underground storage tank,any primary piping,and secondary containment was installed according to <br /> applicable voluntary consensus standards and written manufacturer's installation procedures. Description of <br /> work being certfied: <br /> CIA <br /> 61 <br /> .111.TANK OWNEWAGENT SIGNATURE <br /> 7=MTUOF�TAN7KOWNER"-W DATE <br /> Wilt OF TANK OWNERIAGW&44 ------ nTLE OF TANK OWNER/AGENT <br />