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MAR 31 2005 3: 52PM P— LASERJET 3200 p. 2 <br /> cdr wr �uw ao.ac rt 74J3 1.11•JH FLOOR PAGE 06 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS -INSTALLATION <br /> CERTIFICATE OF COMPLIANCE <br /> (one page per(ank) <br /> pipK,i6lgp�q!-•_"---�^•—.cti3:L`...t.':�::.::yczcc_:��_�—a-Y:a.�:•:�'siti-' .niwam4�.:::.:.:...j._.�_— <br /> Pogo _ of <br /> ., .,,..;..,._.:.:�'•;,;;,r,arsr>u.:� .::at:� :r.; - ;(s:.e,.;;:.,:.�:.;,;�,.: ::I�:^ - -�.:;. stet ,,�....;;... .,;•:•.•.,.. <br /> . ..,`•:;...r',: G::�; l�.y 'r"J•Y'\.':,I+, S s�r,•H�.S;DiM�1qyi g:`. <br /> iyF p �-J,I�Y.�tt3 ..wl., aw�• !''�'; 'Ii�' r :ME 1111 <br /> T. ;.�6`u;' :•.r,;l;.I,,,•....r,,.h,:i7.:..r!: .:a"�.�':':'";" <br /> •;�'fda �ASI ..,_,..... .. ,. <br /> WiMEsi NAMs � sir ' + r•. _.. ............ ,�...�_,._...__........- _....... ,. .:... <br /> .TY NA1/a erOaA•Doplr Iluuneis.ly ...... ... ... ... ." <br /> Awns"Worm"off Pori <br /> V513 �-- t <br /> .fAGUT!r <br /> t 71 <br /> (Ch aeIT all Nat opAry1 <br /> E>Y The instiller has been trained and certi led by tha tank and piping manufacturers. <br /> d The installation has been inspected and certilied by a registered professional engineer having edi,cation and <br /> experience with underground storage tank installations. <br /> 3 The installation has been inspected and approved by the Unified Program Agency, <br /> All Work listed on the manufacturer's installation ohecidist has been completed. <br /> The installer has been certified or licensed by the Contractors'State license Board. <br /> l7 The underground-storage tank,any primary piping,and secondary contalnment was ktstalfed according to <br /> applicable voluntary consensus standards and written manufacturer's instalWDn procedures. Description of <br /> work being certified: <br /> ' ; . �u>•`.T�NK'�NEWnGErrrBroili <br /> I i�Yj MIR M�rNR+sMA►RY1eN raMA Y VW BAG AWn1r r M br11 aImr■ro+Mre. <br /> itlrYTIME OF TAM( KT DATE �q <br /> } T1T r:OF TAN K M"EAMGGW <br /> CUPAFORMS(4199) Formerly SwRCD Form G <br />