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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 by Federal Regulation CFR Title 40, Chapter 1, Subchapter 1, Part 280.32 (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 />Years of <br />Manufacture <br />Sizes <br />Unique <br />Identifiers for <br />Field Evaluation <br />(i.e. color, material) <br />Blend <br />Concentration <br />Supporting <br />Test Data & <br />Documents <br />Attached <br />(Yes/ o) <br />STAYFLOW <br />PRODUCTS <br />YSTO <br />WYE STR <br />NA <br />9 <br />1/z" — <br />2" <br />UNPAINTED 304 <br />SS <br />100% EACH <br />1NGREDIENCE <br />NO <br />Manufacturer's Authorized Signature <br />Date <br />N � <br />_ <br />O <br />N <br />�• <br />77 <br />For tanks and piping please list only double wall products <br />Manufacturer: <br />Corporate: <br />Headquarters: <br />Address: <br />Phone: <br />Email: <br />(Insert a company logo below if available) <br />I declare, to the best of my knowledge and belief, that this affirmative statement of compatibility and the information contained herein is true, <br />I C) VY1 V UW'2. <br />correct, and complete. <br />SCS V S A -ss Uc • <br />r. <br />Title <br />N <br />Manufacturer's Authorized Signature <br />Date <br />N � <br />_ <br />O <br />N <br />�• <br />77 <br />411)n1)q <br />