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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -INSTALLATION <br /> CERTIFICATE OF COMPLIANCE (urle page per hark) <br /> t'eSe 7 or-1 <br /> L FACILITY IDENTIFICATION <br /> BUSINESS NAME(Sa—L TAOUTYWAMI.rDNA-Duinpffusinc&n 3 <br /> E.F. KLUDT& SONS, INC. <br /> ADDRESS(F.,lm,4 t,se Daly) 476 <br /> 1126 E_PINE ST.,LODI CA 95240 <br /> FACILITY IDN ' TANK ID N 477 <br /> Tank No. 7-UG <br /> II.INSTALLATION <br /> (Check all that apply) <br /> 47t <br /> ® The installer has been trained and certified by the tank and piping manufacturers. <br /> 0 The installation has been inspected and certified by a registered professional engineer having education and experience 479 <br /> with underground storage tank installations. <br /> 480 <br /> The installation has been inspected and approved by the Unified Program Agency. <br /> 48i <br /> C] All work listed on the manufacturer's installation checklist has been completed. <br /> 48? <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 OWNER/AGENT SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my kzwwledge. <br /> S1GNA �F NK ERIAGENT DATE y <br /> 484 <br /> NAME OF TANK.OWNER/AG (print) 485 TITLE OF TANK OWNER/AGENT 486 <br /> STEPHEN KLUDT PRESIDENT <br /> UPCF(1199 revised) 14 Formerly SWRCB Form C <br />