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-7 CP <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - INSTALLATION <br /> CERTIFICATE OF COMPLIANCE (one page per tank) <br /> -- Page_of <br /> I.FACILITY IDENTIFICATION <br /> BUSINESS NAME(Same as FAClUTY NAML or DBA—Doing Business As) . <br /> U .SA- 3�ss _ <br /> ADDRESS(For local use only) 476i <br /> FACILITY ID# TANK ID# 477 <br /> II.INSTALLATION.. . <br /> (Check all that apply) <br /> ® The installer has been trained and certified by the tank and piping manufacturers. 479 <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 /> The installation has been inspected and approved by the Unified Program Agency. 480 <br /> ® All work listed on the manufacturer's installation checklist has been completed. 481 <br /> [� The installer has been certified or licensed by the Contractors' State License Board. 482 <br /> The underground storage tank,any primary piping,and secondary containment was installed according to applicable 481 <br /> voluntary consensus standards and written manufacturer's installation procedures. <br /> Description of work being certified: <br /> s-eeov,, r j ��u .ewt- ��i l�t u S tel. T1 .(u -su.mvLf <br /> III. TANK OWNER/AGENT SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF TAN O R/AGENT DATE n f 494 <br /> Ou u.w V l,0(( l{of <br /> NAME OF TANK OWNER/AGENT(print) 485 TITLE OF TANK OWNER/AGENT 486 <br /> UPCF(1/99 revised) 14 Formerly SWRCB Form C <br />