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Jul 18 11 09: 38a Elite IV Contactors 12094Glr342 p. l <br /> 1JN�IED 11tOGItA1►' CONSOL.)_CED Ff>I S'S'= <br /> UNDERGROUND•STORAGE'T�i�T�,.C'ERTIFZCATION.OF Il�TST`.AI�L•ATTO9 MCA <br /> TA <br /> <. ,One fomiperpro : <br /> FALID-*( zUse Oy . ..: <br /> _ <br /> 3. <br /> BUSDIESSNAME.(Smneas"F.acrkNmwenrDBA-DoingB=dm Ar)..• <br /> BUSDMSSI'IEADDRESS _ 10i CCTY <br /> .5TO�77 i <br /> WORF:A 'iHORIZFDUNDER.PERMIT <br /> IyPEOF':MOJECF.(Ck&4dIIth� I.,.ORTtE ;.•(N s rJ�a •. <br /> i fl'.1.:T-MDWALLAVON I'I At lETli' :' :. <br /> :.jj 2 PXPING7NSI`ALL.TM <br /> .OR RF1'LkC Ej TT. .' G' 'J 1. `• <br /> J]:3-SfI1&1NST 7X0W0 R£PI rU iT :'�•. I <br /> -0,4.:-UNDER-DISPENSEP CONTAUOAERT TN A7.I:A•2'I011.9R'3tEEI <br /> DFSCRg'MON OF WORK;BEINGCEft EM).:.. <br /> 1CiSu u'i: s �-6'�-,2,f ..1y) -t <br /> ' 7��•'2�j� mem- �n � 'c�n 3�.'ps�c'.t�:�•��='�'�i ��.•Atsc� c+nee�•c�:Et�e.�•pipes• <br /> 1;�, ;sO; <br /> � <br /> cx�:�tl Aer: <br /> no�d �..�a�� ;" pzri�fa�i� :�i� •�:o�•�'i� = R1: F�t1� S��Q•�-�n -�he3 . <br /> . �b'S-711.!�� tTapr- • : . <br /> ,z <br /> ' �l�t'- c����.c�iM�i�s c��•e� 3.:��'��s��7/���'r ����'����< �'/•�3�) �''z � �'r�• - <br /> XAME OF CONTRACTOR WHO PEEtFORNIED INSTALLATIDPN MODEW.U10N. <br /> 492r- <br /> Wit,-1'C'�.��� <br /> CONTRACTOR LICFJ`ISE# ?CCCE[t'CIFICA2IOI+T# 17 `1 <br /> I certify that the mfocma�on provided herein.is_fine,accurate,and�fiat thefol[owiag coy 9iiions')iavt Lissa satisfied: <br /> n.-C inst Crhas met thexoq* meats set fordL in 74 CCR_§27..15, bdiyisioas fig),and(Is, <br /> • The imdar d s irage,tank, any.Pte'. PiPingi• 'an3"'s ?ada<y, batamauesit sas ;astalled accordim�g to applicable.. <br /> valudtar :consen assb�ada rds and auy ma4af tCb er's wr;!=jastaliati instxa <br /> .. ..All vork listed ink 's and certified <br /> :iasfailationi;diecidist:has�eeu co�p <br /> - lcfed.:chops. <br /> Tho instal}atioa has':ti inspected and approved`.hy the Tocat.aget►a9;oz:if required byl :loeal agency.;aspected c <br /> d. . ea•hay=educaaion and'. Fence witli im&imuod s r e stai126ons. <br /> SIGNi4 QF TANK <br /> aR awl�x•s AGENT tTS �xorrE.: <br /> , <br /> s.iv;;a�- .. .� �• . ',_�;,� Vis ;:..: • .�` _ _ �.: <br /> :. <br /> ese:.: CT�7FR INSFI� U:;�CI�KAWNEI! ate_. <br /> Mle'OF CERTXFII3t S LO'YER.�BAj .. ._ .'SREC RATIO .. <br /> rnr>tao�vr�st :I'z zat�Pxrox ' <br /> •�f.:k':LC,t�`�.::��C'� c�c�s� �C;�:': 3 <br /> • .. •. 'S:�TFIEZ AUX'HOR=A E=I1T OF'F;ANK:O�Y19E[t <br /> jam! ... - —• •-- <br /> _ IUL 18 2011 <br />