Laserfiche WebLink
Jan 29 08 09:56a Elite ry Contractors Inc 209461.8342 <br />0 10 <br />UNDUD PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND ! ' ! <br />CERTMCATE OF COMPLIANCE <br />P • 1 �� <br />?ne page per tank) <br />Page _ Of <br />L FACHXff IDE CATION <br />s. <br />BUSINESS NAME < �FA4nsn-u«R tress ns) 2 <br />l ' 1 <br />ass. <br />ADDRESS (Fariowuseonty) r R <br />477. <br />FACILITY M# <br />1• <br />TANK iD <br />IL INSTALLATION <br />(Check all that apply) <br />r 476. <br />The installer has been trained and certified by the tank and piping manufacturers. <br />479• <br />��e installation has been inspected and certified by a registered professional engineer having education and experience <br />with underground storage tank installations. <br />The installation has been inspected and approved by the Unified Program Agency. <br />481. <br />ff�A ll work listed on the manufacturer's installation checklist has been completed. <br />462. <br />[The installer has been certified or licensed by the Contractors' State License Board <br />BECE I <br />The underground storage tank, any primary piping, and secondary containment was installed accor <br />voluntary consensus standards and written manufacturer's installation procedures. <br />Descrition of work being certified. JAN 2 200 <br />C i 7�C i <br />�cf NM <br />• �� �� <br />(�.(. f <br />, t <br />, q l-- <br />7-a <br />B1 TANK O RIAGENT SIGNATURE <br />I certify that the information provided herein is true and accurate to the best of my knowledge. <br />SI ATURE OF . ANK OWNEIUAGENT <br />DATE tfwA 44' <br />lk4AME OF. T K OWNE ENT (print) 45 <br />TITLE OFT O/W' NERIAGENTTech <br />1 < d- ' <br />U1PCF (1/99) Hwfwrc-c -12 <br />http-.//www.aaedocs,ocg <br />Rev. 62!16/00 <br />Ll <br />in <br />M <br />