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I:NIF'fF.D PROGRAM CONSOIJD:1-VED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANK -`INSTALL-..A'I ION <br /> C'G:R'1'I1 IC'A'f E OF COM 10111 Imp IW.11,111,0 <br /> 1 <br /> I. F'AC11.1`I V [I)ENTIF'I('ATION <br /> i11+SINI SS NAM ,sm,wml %ru.1'1'ti.NNIV.,Iill% I,,n,,, 11-1.,A') <br /> w <br /> ye,r'lLIT <br /> II, INS'CAL.L.ATION <br /> The installer has been trained and certified by the tank and piphq I11.rnUfilcllifef5, <br /> ❑ The installation has been illSpcctcd and cci'titied by a registered protos4ional engineer having education and experience <br /> WWI undcrbrpund StoragC+.Erik installations_ <br /> L`J <br /> 'fhr <br /> installation has hren ittspcc;tcd:Ind ilfrproviil by the t inilwcd Nnraruln /1crnq. <br /> All Wlrffc IFSIGd on the rtEaIIUfaCturCC'S installntiall checklist has been completed. <br /> xx 2 <br /> The instalier has been ccrtified.nr licpsed by the(lontractors- State License 13trard. <br /> ❑ The undergrourid starage wrik,any prim[" piping,and secondary conminment was installed according to applicable 5 ' <br /> voluntary consensus siandards and written manufrc:lurer'S instullatiun Procedures. <br /> f)csl ription e,I'work being cortifio& <br /> II1. i"ASK[)WNF:]lt/A(aati'L'SICNAi'liR� <br /> I Cvli fv that 41W 11,41r,T)U6011 prc,ridod h¢reul i%true a1,d ucurtlte so the WNl,Ii Int kno,eludyu <br /> til(�Nlftlflr�{L. 1bVN1 lil_�� x� `:� 7. '""",, .— .._.�_ �w• <br /> 1111(� <br /> '.ltwliii.{:<�rrrxy#:ci�.S•ur,K <br /> N•\t11:I,h ITNhI11k�Nli{Zr <iF';I'I' ,LIIII <br /> I IP(T f 1i9i1 revised) 13 formerly SWR('B VoTM C. <br /> Z0 39vd HD-1V9 TCT0Zb689b 60:TT L007,18011T <br />