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UNUMD PROGRAM CONSOLMA7 EJ)FOM-vi <br /> THINKS <br /> UNDERGROUND STORAGE TANKS --INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> (One page per tank) <br /> ;< ' '.•L FACII.iTX)IAENTiF�CATIUj�-. .. z �: ,. - <br /> BUSOf— <br /> NESS NAME(Srmz As PACIt1TY NAnta:of V0A-wino A�) <br /> Rancho San Miguel Market y. <br /> A1?nRFS$(Fer[=I We only) <br /> 476, <br /> x *9-Air ort Way Stockton CA 95205 <br /> FACILITY IDN e. TANK iD 1 <br /> M INSTALLATION <br /> (Check 211 that apply) <br /> ® The installer has been trained and certified by the tank and piping manufacturers. 471, <br /> ❑ -The installation has been inspected and certified by a registered professional engineer}caving education and experience ars. <br /> with underground storage tank installations. <br /> The installation has been inspected and approved by the Unified Program Agency. Oto. <br /> All work listed on the rnanufacmrer's installation checklist has been completed. W. <br /> 4" <br /> The <br /> The installer has been certified or licensed by the Contractors'State License Hoard. 4 <br /> ® The underground storage tank, any primary piping, and second y containment was insralled according to applicable d". <br /> voluntary consensus standards and written rnauufacturer's instal!-;ion procedures. <br /> Description of work being certified: <br /> Installation of Elutron underground fueling system that has <br /> a two compartment storage system 15,000/5,000 <br /> ID.TAMC 0WNERIAGENT SIGNATURE <br /> I certify thea the Inform2don provided herein is true and accurate to the best of my Imowledgt. <br /> SIGNATURE PFJAN K O WNWAGENT DATE 463. <br /> NAME OF TANK OWNERlAG T(print) '1s TITLE OF TANK OWN tpjArEWF146. <br /> Dennis Cove Director PAQ Inc. <br /> L'PCF(1199)Hwfwrc c-112 http//4rww.onidacl org Rev.OVICUdd <br /> V 39dd dMIJ Hldi3 15:91 coot/90/1I <br />