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Ak As <br /> _, IFIED PROGRAM CONSOLIDATED F00P <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> CERTIFICATE OF COMPLIANCE (one page per tank) <br /> Page <br /> CIL DE„ [IFICATION <br /> 3 <br /> BUSINESS (Same gs FA[ILITV NAME or DBA oing Bugineas7 _ /r I� <br /> /,'j /V,`,�.{).1�(f'.�lC/ V 476 <br /> ADDRESS(For�ogel ur se only) v <br /> CAL <br /> S�J�� <br /> FACILITY ID# f Y� (� RC1 `1 jT�A.NK ID# V 477 <br /> t rt"fl DSI S7� <br /> II. INSTALLATION <br /> (Check all that apply) <br /> 478 <br /> ® 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 478 <br /> experience 480 <br /> ® The installation has been inspected and approved by the Unified Program Agency. <br /> 481 <br /> ® All work listed on the manufacturer's installation checklist has been completed. <br /> 482 <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 483 <br /> applicable <br /> Description of work being certified: <br /> I cerk,- WNE <br /> vided herein is true and accurate to the best of my knowledge. <br /> SIGtl <br /> II I RIAGENT DATE r 4B4 <br /> Svi ? o7 <br /> AMENT int) 485 TITLE OFKOWNER/AGENT 435 <br /> I <br /> UPCF (1/99 revised) Formerly SWRCB Form C <br />