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a1i Ji W Jr dr W �Ir alr Jr Jr dr B� J alr .•G • <br /> Ir�p� q•, ij� q� Oma. '1` 19 'j` 'p, 'P '1` 'p q` 'P '1• 4` `+''1 <br /> arr CERTIFICATE :., ��� <br /> OF INSTALLATION <br /> FOR THE <br /> PLASTEEL° ELUTRON® UNDERGROUND <br /> TANK <br /> In compliance with part 280 of Title 40 of the Code of ELUTRONO TANK DATA <br /> Federal Regulations,this document may be implemented to <br /> meet Subpart B,paragraph 280.2(e), CERTIFICATION OF The U.L.Label and serial number is on the top centerline of the <br /> INSTALLATION. tank and also listed on the delivery document. <br /> _!C The installer must initial all sections below representing SIZE IN GALLONS U.L.SERIAL NUMBER <br /> ��� that the installer has read, was cognizant of and has com- OR1 <br /> pleted, as applicable, all sections of the PLASTEEL" <br /> Sr_ ELUTRONO Tank Installation Instructions attached hereto. <br /> Return completed form to manufacturer to activate <br /> warranty. <br /> INSTALLATION CHECK-OFF <br /> Wrol COMPLETION LIST INSTALLATION COMPANY <br /> .r� . <br /> I SECTION INITIAL DATE <br /> l2j 12�1 1, GENERAL NAME <br /> %V; Ji <br /> II.VISUAL INSPECTION <br /> M III. HANDLING ADDRESS <br /> IV. EXCAVATION DEPTH, BEDDING AND SACKFILL <br /> ,:i:. n•. <br /> V. ANCHORING SYSTEMS CITY,STATE.ZIP <br /> l ) <br /> VI.TESTING TELEPHONE <br /> =!' VII. VENTING: JACKETED ?j•. <br /> "• � INSTALLATION COMPLETION/SUPERVISOR'S SIGNATURE <br /> VIII. PLASTEELs SEALING PROCEDURES <br /> .Ii INSTALLATION DESCRIPTION The responsible supervisor's signature below represents __r; <br /> that phases 1 through VIII were properly completed per the '�`� <br /> IRS <br /> INSTALLATION SITE PLASTEEL9 ELUTRON`s Installation Instructions: <br /> r1•. <br /> ADDRESS SIGNATCRE DATE <br /> „• CITY.STATE.ZIP PRINT FAME <br /> 1� PLASTEELs TANK OWNER YOUR PLASTEEL' TANK MANUFACTURER IS: <br /> jti <br /> P til. <br /> NAME NAME <br /> •Ir „� <br /> ADDRESS ADDRESS <br /> CITY,STATE,ZIP CITY.STATE.ZIPri <br /> i,• I 1 1 .iii. <br /> SIGNATURE DATE TELEPHONE <br /> i.: RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVATE WARRANTY <br /> FORM INST CERT-1193E <br /> aliJJ !P. !1�. I FP. . bl . .JAi. . 11i•. 1;• i Jai i a <br /> ."'.'jam. 161. .11, .111. ali li_ �•.. <br /> .ilk. .il�. .il•. JI•. ' <br />