Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> CERTIFICATE OF COMPLIANCE (one pale ler umkl <br /> rmnr_ter� <br /> I.FACILITY IDENTIFICATION <br /> BUSIN FSS NAMI JS.h c as I ACIZ.rTY NAMI:o,I)BA bourn@ Burins.Asl <br /> E.F. KLUDT&SOUS, INC. <br /> ADDRESS IF-Inew use only) 476 <br /> 1126 E.PINE ST., LODI CA 95240 <br /> FACILITY IM I TANK ID H 4aa <br /> Tank No. 6-UG <br /> H.INSTALLATION <br /> (Check all that apply) <br /> 478 <br /> ZI The installer has been trained and certified by the tank and piping manufacturers. <br /> ❑ The installation has been inspected and certified by a registered professional engineer having education and experience 479 <br /> with underground storage tank installations. <br /> 490 <br /> pq The installation has been inspected and approved by the Uiufied Program Agency. <br /> 41 <br /> ® All work listed on the manufacturer's installation checklist has been completed. <br /> 483 <br /> ® The installer has been certified or licensed by the Contractors' State License Board. <br /> ® The underground storage tank,any primary piping,and secondary containment was installed according to applicable 483 <br /> voluntary consensus standards and written manufacturer's installation procedures- <br /> Description of work being certified: <br /> INSTALL NEW TANK TRIM AND UNDERGROUND PIPING. <br /> INSTALL NEW UNDER-DISPENSER CONTAINMENT&MONITORING SYSTEM. <br /> III. TANK OWNERJAGENT SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGN) TA REAGENT PATE / 484 <br /> Cp— <br /> 14. <br /> NAME OF TANK OWNER/AGENT(print) 485 TITLE;OF TANK OWNMAGENT 4M <br /> STEPHEN KLUDT PRESIDENT <br /> UPCF(1199 revised) 14 Formerly SViRCB Forth C <br />