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Nov 18 14 08: 03a Elite0Iv Contractors Inc 2094612
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<br /> UNCFIw PROGRAM CONSOUVATED FOAM
<br /> UNDERCROUND9TORACETANK ; ENVI
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<br /> CERTIFICATION OF INSTALLATION/MP(DAIRi pgRTMENT
<br /> 1 1 loll III (One form.pet project)
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<br /> 'Tl'PS OF PR 7ECr yCkrk u/l rhnlrmN�Ji6 WORK AU'fl'tORIZED UNDG YL'RMI7 4M
<br /> ❑ LTANK I57ALLATION OR REPLACEMENT (N�ber or Dalc)7
<br /> ,❑ 7 PIPING NSTALLATION OR REY4ACEIrffidT
<br /> .❑1,SUW,ISTALLATTON DR RGI+L/tiCEMENT l ! ,
<br /> ❑4,UNDER DISPENSIIt CON7�,iNMCN7 WSTALLATION OR 1tIIPLACP.MEN'P `)�"� - �'� ��
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<br /> AMC OF COivrFAC70R WHO PERFORMED INSIALI.ATTON I MODIRCATION 4w
<br /> CONTRAC70R.LICENSE# 1°$1y ICC'CELTIFICAnON#
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<br /> T certify that the infurmation provided herein is true,accurate,and that the fbih+wing conditions have been satisfied:
<br /> • The installs has met the requirements set fords in 23 GCA§2715,subdivisions(g)and(h).
<br /> • The underground storage ttmk; any primary piping, and any secondary containment:was installed abcording to applicable
<br /> voluntary eoosenam ntaadards and any manufacturer's written iusttdhdiun inshuctions.
<br /> • All work listed in the manufactuieei installation checklist has been completed. li
<br /> • The installation has been inspected and approved by the local agency,or if required by the local ageuey, 'nspected and certified'
<br /> ragistered rofessional en '{leer Navin eduGadea and experience with underground story�c ttmk syste installations,
<br /> SIGNA(UI[ Y'IAN OWNF Y( WN r '8 AGENT - DATE t 414 PHONE 11 f 41n.
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<br /> NAME OF CERTIFIM'S I-ARIAYE,(DBA)'' r °�' CEtTIMER'S RELATIONSTM TO TANK OWNEK 4YA
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<br /> 3.COMPACTOR ❑ 4.PROPERTY' z5l
<br /> S.OTHER AVrHoKize"DVinr'OF TANK O NFR
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