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MAR 25 '04 16:12 FR CPgTCO GASOLINE 425 427 7119 TO 912094640138 P.03/04 <br /> 0J14JILVV4 14:4/ Zn1j4)tle.b COSTCO WHOLESALEPAGE 02 <br /> naR 2504 12:27 FP. COSTCO GASOLINE 125 427 7119 TO 9120276 P.01101 <br /> UNIFIED PROGRAIINI CONSOLMATfiD FORM <br /> T.Au4KS <br /> UNDERGROUND STORAGE TANKS-INSTALLATION <br /> CERTMCATE OF COMPLIANCE <br /> (0.give M LVk) <br /> .. Paac,�err <br /> C.FACII.ITX IDENfIFICATiOIv <br /> auStN SSS A ,a.+s a.in.4/VCO o/w-o.tiar-+w,w Ja s(/y <br /> L-e vw z�r aw 2'2/d <br /> '\C� IDe I TAN <br /> II.INSTALLATION <br /> (Chak at thu apt» <br /> ca <br /> The installer has beta trained and certified by the lank and piping rnanufact uets. <br /> LJ The installation bas been iDspecttl Pad cersried by a registered professional engineer ha7ng education and experience <br /> with underground storaEe wank <br /> ,n <br /> installations. <br /> no <br /> The irsuaWtioa has Seen inspected and approved by the Unified Program Agettry. <br /> ui. <br /> 3wo,01 work listed on the nwnufaetarer's installation checklist has been compltned. <br /> 4l <br /> The installer has beta exttified or licensed by the Contractors'State License Board. <br /> � <br /> �\•l�< undeugsound storage tank, any ptierary piping, and .secondary oontainmen was installed acmrdiog to applicable ws. <br /> .olutrary consensus standards and written manufactures installation procedures. <br /> Description of work being certified: <br /> III.TAn OWN11 WAGENf SIGNATURE <br /> I...ny�•Ne mrmmauoe pro.ia.e aareia,a w.am sc,ra.m ere baton tar bwvlaMge. <br /> tDNA iEIUAa T DATE <br /> NAME OF TANKD I .AGatfT(Etat) •a Tt TANK Ow`rER/.\GEM <br /> n t vt k h iir�sr� Rvs G.r <br /> tItCF p19f1 HwA.ttt•12 Alta d/ww...uueara we Ra+.aan"C' <br /> TOTAL PAGE-01 eaa <br />