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Jan 13 11 01 : 19p Elite IV Contactors 120946342 p. 1 <br /> �4 <br /> CLRTMICATION OF INSTALLATION TMODIFICAITON <br /> wR ��"" .. �_ - _. x :. ,•�';�+y4 _..:�....iGa}A� `zr'lU�r,s��� ���'- <br /> rAL,LL.11I W-0(Agemy use cwy) <br /> By§pl=NAMEE(SameasF.adMy amcarDBA-DoingBudn=-4s) <br /> ss <br /> r1E.9D S. n3_ <br /> CITE . toe. <br /> - ^: ,��x-�{'3...rf •�s.: SskYti,3r' ..e`�•,y' <br /> :TYPE OF PROJECT(CJ�eekall itiaa anvly} 4FJa WOMALITHOP,=UNbER PERMIT <br /> )] 1.TANK R�S'TAX!AnONOR�PLA[�,Z':. . (Numl:erorDatr).112-PIPING JNSTALtAtON�OR�+IACIMtf 4 . <br /> :3.'SrIW INSTTALLA toY OR REPLANT <br /> 0"4.UNDER DISPEASFA COA'TAINMENT D4STALLATION OR REPLACI TT. + <br /> ❑ s.OTE�R <br /> -DESCMTION1JE-M) F BEIb►G.0 TIFIEDr- -.- ��_r �_ �:. <br /> ? � �'��' ,y�'��'-,-� ^N ���- s,: ,..s:,-.--�f amu.. Y':.., —vyx•.as x-m ty,;,r„1•. , <br /> _ -�ts � 'r:. -t7' t�4• �.. '�s�"yS..'.:�G: �•..ka�ra��;.sa+: � � ^' .1'�^�' + -?t � ."sa`S�,w,:• '� '�`P�. <br /> - <br /> N OF CO CTOR WFF PERFORMED f�STAI LAII /MOD�ICATION a <br /> CONTRACTOR LICENSE `'E` ICC'CERTIFI TIO �� asaz r <br /> - ,,7+R, .•.Rk�-,y'l6SYn7a^:* L.+W'Z�'y .L ti,.,,p w.. �e4 a st a .n <br /> YK S•.. .Nfi`LMYrM <br /> I certify that the YaformAdon proAded harem is true,accuratx,and that the foIlowinb conditions,have been satisfied. <br /> • The installer bas:met�ezequix:naeu>�S set fazth,in 23 CCR§27.1 a;si�cJt�sioas(g)and+(!n) <br /> undergrotmd ssurage .tank- .any primary.piping, and-any secondary coma nment-yvas installed according to applicable <br /> - -:vollmta7 consensus Stas dards nd'an3':mani�iac�merIs written moa nst�vctions <br /> • :.AI]work-lister in the manufaefu=S-in sIladon rhecklisf has`becn.aomglefed <br /> �_ . The:instaflafron has.been imi pected and approved`by ihe,lacal-agency,`or ifregtiired by the local agemp},inspected and ccrtif ed <br /> b registered rofrssional a e bz%ima education and i "ence with im_dei',muod storage t=k em-installations. <br /> SIGMA ANN-OWNER OR OWNF�R'S AGENT .41 <br /> sae <br /> 's N (P',. CF1R 5. J <br /> ass <br /> NAA3E OF CERTETER'S E&WL-OXER SA ata r 40. <br /> } CERT R'S RELAT7ONSHT T M.TANK O WId.iR <br /> CIA � c:�ii�'�Yc��: Q i:rawN> Q �rr+haicaP>rKx�TQR <br /> tai's, in �.ccallvzx�crol� Q' . ROI�TYOWNER <br /> :rIUTPIORIZID AGEhIT OF TANK oWN� . <br /> StockI��''! <br /> U?U-UST-C p,,.(2T�6�} / 520 <br /> nrnw onidorso.-. <br />