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U LT RAZO L®GA9058 <br />Manufacturer's Affirmative Statement of Compatibility <br />(As required by California Code of Regulations section 2631(k)) <br />As required <br />by Federal Regulation CFR <br />Title 40, Chapter 1, Subchapter 1, Part 280.32 <br />b 91 ii <br />Manufacturer(s) <br />(including prior <br />marketed names) <br />Model <br />Component <br />p <br />Type <br />(i.e. pipe, <br />tank, etc.) <br />Current <br />UL <br />Standard <br />Listing <br />Unique <br />Years of Sizes Identifiers for <br />Manufacture Field Evaluation <br />(i.e. color, material) <br />Blend <br />Concentration <br />Supporting <br />Test Data & <br />Documents <br />Attached <br />Yes/No <br />Petro Clear <br />40530P <br />Filter <br />VXYV2 <br />Red Color <br />NA <br />NO <br />Petro Clear <br />.75N1-12 <br />Adapter <br />'e <br />Black Color <br />NA <br />NO <br />I declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained hrrejn <br />i,,$srue, <br />correct, and complete. <br />=_ <br />^; <br />Kris Stanhope <br />Engineering Design Manager <br />Pr' <br />It Name <br />Title <br />For tanks and piping please list only double wall products <br />(insert a company logo beiow it avanaeie) <br />Manufacturer: Champion Laboratories, Inc. <br />Corporate: Champion Laboratories, Inc. <br />l <br />Headquarters: <br />Address: 200 S 411 St. Albion, IL 62806 <br />_ <br />N <br />Phone: (618) 445-6011 <br />=, <br />Email: Kris.stanhope@champlabs.com <br />'e <br />I declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained hrrejn <br />i,,$srue, <br />correct, and complete. <br />=_ <br />^; <br />Kris Stanhope <br />Engineering Design Manager <br />Pr' <br />It Name <br />Title <br />Manufacturer's Authorized Signature <br />2 /15 20 23 <br />Date <br />