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INSTRUCTIONS 4'Its FORM "C': T 1 ST 1CERTIFICATION <br />GENERAL I I T l T S <br />1; Each tank system must be in lin with the federal and state technical <br />standards, law and negrul t@ ns, for teak sad piping installation, <br />This erh lco*4o,,n be completed by ;either dine UST owner or representative. <br />One certification i's required for each tank system" This form shall be used to <br />make the required certification. <br />4. Please type or print clearly all requested infor tin (tor printing, please use <br />hard point wr tl+ r instrument). <br />Submit the cornple ed to the appropriate Local Implementing Agency. <br />1. INSTAL TI IMA 6 ALL OF THE ITEMS THAT APPLY TO INDICATE THAT T THE <br />INS"I'ALLATION REQUIREMENTS ARE MET. <br />11. T. THE TANK :O l TSHALL, CERTIFY, BY SIGNING THE <br />CERTIFICATION, THAT THE INFORMATION PROVIDED IS TnLJE AND <br />CORRECT. TH " PERSON'S NAME SHOULD PRINTED UNDER THE <br />SIGNATURE. <br />i <br />