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ULTRAZOL®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, Cha ter 1, Subchapter 1, Part 280.32 <br />b 91 ii <br />Manufacturer(s) <br />(including prior Model <br />marketed names) <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 Identifiers for <br />Manufacture Sizes Field Evaluation <br />(i.e. color, material) <br />Blend <br />Concentration <br />Supporting <br />Test Data & <br />Documents <br />Attached <br />(Yes/ o) <br />Petro Clear 40530P <br />Filter <br />VXYV2 <br />Red Color <br />NA <br />NO <br />Petro Clear .75N1-12 <br />Adapter <br />C_— <br />Black Color <br />NA <br />NO <br />n <br />I declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained hire -n <br />i1grue, <br />< <br />correct, and complete. <br />i L <br />w <br />�' <br />Kris Stanhope <br />Engineering Design Manager A <br />C <br />Pr' <br />t Name <br />Title <br />For tanks and piping please list only double wall products <br />(Insert a company logo below if available) <br />Manufacturer: Champion Laboratories, Inc. <br />Corporate: Champion Laboratories, Inc. <br />Headquarters: <br />Address: 200 S 411 St. Albion, IL 62806 <br />N <br />Phone: (618) 445-6011 <br />=, <br />C_— <br />C� <br />Email: Kris.stanhope@champlabs.com <br />=_ <br />n <br />I declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained hire -n <br />i1grue, <br />< <br />correct, and complete. <br />i L <br />w <br />�' <br />Kris Stanhope <br />Engineering Design Manager A <br />C <br />Pr' <br />t Name <br />Title <br />Manufacturer's Authorized Signature <br />2//s�2,o23 <br />Date <br />