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MRR 25 '04 16:12 FRCOUCO GASOLINE 425 427 7119 TO 912094640138 P.02/04 <br /> cu�4,ooc 1.u511U WHULE-d-LE PAGE 01 <br /> MAP 25 '04 12!27 FR CObi GASOLINE 425 427 7119 TU 912096 P.01/01 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS-INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> (One Peae PeT telt) <br /> Peie�a! <br /> L FACILITY IDEN171FICATION <br /> BU. 55 NAM +COIN rvnYaer OpYq. ray 9 <br /> n t <br /> 4'-1 ZJ(� ». <br /> FACT [IM TANK m n ,q�.�n •+. <br /> H.INSTALLATION <br /> cele all tMt aPWY <br /> •a. <br /> [�o Installer has been Baitted and oaufad by the ta[dt and piping tttmufacturero. <br /> Q The matalladoa has been inspected and cerutled by a ropstered professional engi =laving tducation and experience <br /> with underground stotase tads instalLLtions. <br /> c inaWl.Hon has been inspected and approved by the Unified Program AgAgency. a. <br /> fla-INr. <br /> All work liacad on the tnanufacmrer's instillation Checklist has been mttspMad. <br /> ,,.,/Talk .i <br /> �,��y,,,,"``he iuecr has been or licensed by the CoaKaelws'State Liable Board. <br /> LL�The mdwarotmd atotasC tank, my p may Piping, and secondary coniam eezu was installed according to applimbic <br /> voluntary corneum ttuKtaads and vmtten mmufactuter's matatlatim pro..dures. <br /> Description of work being cerdtled: <br /> In.TANK O WNERIAGENT SIGNATURE <br /> t amWy mat amedOtetatioaPNNdeC harm waw MA a acumta to At bora!my loo ) dee. <br /> atONA 7ANK0 arAneNT pp 3 ZS + N. <br /> NAMED KOwNMA0B q - Tt17F.�F TANK OWNlIUA as <br /> e 0 YJ I S �o Gafr /. .tee <br /> VPCF(IMP)Nrtlrmc-lR MIp9Mww.rreWoo.ata It",OL16060 <br /> *s TOTaL PAGE-01 r,s <br />