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INSTRUCTIONS FOR COMPLETING FORf)l ''C": TANK INSTALLATION CERTIFICATION <br />GENERAL INSTRUCTIONS <br />1. Each tank system must he in compliance v4th the federal and state technical <br />standards, contained in law and regulations, for tank and piping installation. <br />2. This certification shall be completed by either the UST owner or representative. <br />3. One certification is required for each ttaW nys'iern. This form shall be used to <br />make the required certification. <br />4. Please type or print cli;:�Av *Ii requestedJ -Fr�'tnation (for printing, please use a <br />hard point writing instrump-ity'I- <br />5. Submit the completed certification to the appropriate Local Implementing Agency. <br />1. INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE <br />INSTALLATION REQUIREMENTS ARE MET. <br />Il. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE <br />CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND <br />CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE <br />SIGNATURE, <br />0 90 <br />