Laserfiche WebLink
UNIFIED I`ROGk§!vl CONSOLIDATED FORA <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> (Oaa page per tank; <br /> mm <br /> Page_of <br /> L FACILITY IIIENTIFICATION <br /> j BjJ�N-g7NEi�,(SmauFACIl7^i\,�]ffia7eA-fl�gaui�sci+1 --_.-----___—�_ <br /> �•. L+ C�'��� _._�A.--.__ ___ 476. <br /> ADDRESS(Ferbul we whl J <br /> FAC UTY DN I 1 <br /> TANO u CI Or 000 <br /> if.INSTALLATION <br /> i <br /> -- (C}a&all that apply) <br /> 410. <br /> The installer has been trained and certified by the tank and piping manufacturers. <br /> 379. <br /> ❑ The installation has been inspected and certified by a registered professional engineer having education and experience <br /> with underground storage tank installations. 389. <br /> [] The installation has been inspected'and approved by Unified Program Agency. <br /> j 4n. <br /> ® All ciork listed on the manufacturer`s installation checklst has been completed. <br /> II 38?. <br /> The installer has been certified or licensed by the Contractors State License Board. <br /> The underground storage tank anv primary piping, and secondary containment was installed according to applicable 493' <br /> 1111 voluntary consensus standards and written manufacturer's installation procedures. <br /> 1 Description of work being certified: <br /> I <br /> f <br /> 1 <br /> + <br /> M.TANK OWNERlAGENTSIGNATURE <br /> f Icetafi that:.he wtomiatip resided he '.6rnreaad acc,u a tothe best of myktrowledge. <br /> --�—DATE <br /> e1G�ATt RE T 7-16 a <br /> j 666. <br /> u!. ; TTTLE OF TANK OVJ!JFQAu/t <br /> Or TANK 0ANER)AG£NT(prim Y <br /> Re..62116100 <br /> UPCF(it")Tlarfwrc�•S7Y <br /> hnp:;ha�vr.uatdac..org <br />