Laserfiche WebLink
Flug 22 11 06:21a Elitp IV Contactors 12094616342 p.2 <br />UJITJMDPROGRAM .CONSOLIDATE:t) I)RM <br />UNDERGROUND STORAGE TAM <br />CERTMCATIrON OF INSTALLATION )- J 9F OD <br />_-(COt form.perpmjecty _ <br />m 7 . � � 2� til i <br />Ky'r. "••.__'4h .. x5es'v`k;+n:�•.a •r.ur...w., '.l 4.it�v+is <br /># (�genCJ' Use OnljJ •^-*,�, a <br />Iv1E (Same as <br />NameorDB,—DoingB,ix=s q,) <br />—TYPE -0F PROJECT i(Che.;,Fa!! that Zv <br />Q <br />'-TANK INSTALLATION OR REPLAC IgEr ,T <br />.02 <br />.PIPING INSTAL .ATIONT OR'REPLACE1vtENT <br />Q 3. SC►Iv1P.INSTAI.7,�lTTON OB REPLACEII�IT <br />04 UNDER DISPENSER CLII�TA II Rv1ENT INSTALLATION OR REPLAC7]v!I?�TT <br />• S.OT•F1ER <br />DESQtff'TION OFWn>rK uFrnTnrcn•,•�.r...- <br />Y-6 CCEj <br />RECEIVED <br />2011 <br />�'FRM1T�a�R ; ME,q�TH <br />aw463. WOE <br />is LTHOR= OND', <br />ER FFR1✓ilT <br />(Nimb nrD=): <br />t11C�:>, �'��•peLrc'�.(C�r1.���7..� �� S��C.1 � <br />.�l ber4us Iqr, r uV*f ti\d :� <br />art uu� cchfic��n�.�_� <br />u•�'+`�irur.nitON/MODff'TCAT70N ._ .. — �:�"�"�`'"`;���*''�. <br />Cl VIC, "M-- CCY\\x14gC`tcRb dnC `ZZ` <br />CONTRACTOR LICENSE # asm <br />CS2�fr L��� ICC'CERTlF7CA77ON# <br />�, � •�� to r2, <br />I certify that the information provided herein is true, accurst _ <br />e, and that the fotlowing cmid `_;ons have been satisfied: <br />• The installer has met the reguirements set forth in 23 CCR V715, subdivisions (g) and (ii). <br />• The rmderground. storage tank, an <br />iToI y Pnm�' PiPmg, and any secondary containment w ;installed according to applicable <br />�rY consensti standards and any mannfacwrer's Written installation instructions. <br />• All Work listed in the manufacturer's installation'cher}dist has been completed <br />• The installation has been <br />by inspected and approved by the local agency, or' -if regnireci by:tit; ."al agency, inspected and certified <br />arefessional ea' mmr havin education and ex erienee •with underground star, t.: tack• <br />51GNA OF TANK OVi'NER OR OWNER'S AGENT stem installations. <br />PHONE . <br />YV y oar.: <br />TVA>Ar; (Adw) . •oars. _ . <br />Il.i d-Iduri a�Tz .Isau.E - 4M. <br />NAME.OF CERTIFIERS 1 &LO yka (DSA) 4U, — <br />CERTRMR'SREIATIONSHIPTi)' aNK:Op, gt os9.. <br />r —.,Mf -0 r. r c owNBR :::..:Ei .: °. 'OPERATOR <br />CONTRACTOR .. 04 PROPERTY OWNER <br />OTHER AUTFIOROM AG': N :)F TANP.:OW.NER <br />Www:unidocs are <br />