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08/01,/2008 15:57 FAX 510 614 3396 PARADISO MECHANICAL Z002 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> CERTIFICA'T'ION OF INSTALLATION /MODIFICATION (One form per project) <br /> 1. FACILITY INFORMATION <br /> IL—LL <br /> FACILrrY ID t+(Agency use only) — <br /> BUSINESS NAME(Syne a FACILM NAME or ODA—Doing Buslo As) <br /> ARCO Facility 406020 «, <br /> UUSINESS SITE ADDRESS 01 CITY <br /> 1711 East Yosemite Avenue Manteca CA <br /> 1I. INSTALLA-79N.'MODIFICATION PROJECT DESCRIPTION <br /> r7l <br /> E OF PROJECT(Check all that_anoly) <br /> — JB34 WORK AUTHORIZED UNDER PERMIT ia3e <br /> I,TANK INSTALLATION OR REPLACEMENT (Numbar or Dstc):2.PIPING INSTALLATION OR REPLACEMENT <br /> Q 3.SUMP INSTALLATION OR REPLACEMENT <br /> Vy ,UNDER DISPENSER CONTAINMENT INSTALLATION OR PLACEMENT <br /> 3.OTHER 400 <br /> DESCRIPTION OF WORK BEING CERTIFIED' <br /> Remove Existing UDC Sensors from UDC'S <br /> Remove (S) Existing shallow UDC'S <br /> Install(8) New Western Fiberglass Deep Style UDC'S. <br /> Re-Install Existing UDC Sensors <br /> III. CONTRACTOR INFORMATION <br /> aAs <br /> NAME OF CONTRACTOR WHO PERFORMED INSTALLATION/MODIFICATION <br /> Paradiso Mechanical Inc. <br /> .P.c <br /> �eao. ICC CERTIFICATION# <br /> CONTRACTOR LICENSE# 45279139-LT1 /#5279139UT <br /> 671909 <br /> IV.CERTIFICATION <br /> I certify that the information provided herein is true,accurate,and that the following conditions have been satisfied: <br /> • The installer has met the requirements set forth in 23 CCR§2715, subdivisions(g)and(h)_ <br /> ■ The underground storage tank, any primary piping, and any secondary containment was installed according to applicable <br /> voluntary consensus standards and any manufacturer's written installation instructions. <br /> ■ <br /> All work listed in the manufacturer's installation checklist has been completed. <br /> • The installation has been inspected and approved by the local agency, or if required by the local agencv, inspected and certified <br /> by a registered professional engineer having education and ex erience with under round Stora a tank system installations_ 97 <br /> SMNATURE OF TANK OW NER OR OWNER'S YNGENT DATE iso PHONE <br /> (Slo <br /> F[FIFR S NAME sprint) CERTIFIER S TITLE. <br /> 1441.0111AIL Vint I1lkLk1 _ <br /> V.\1Icl)PCLR'1'IIILRs1_,�11'L�)YPRi,DB,N1 gas CERTIFIERSRFI_ATICNSHIPI0'IANKO%VNER <br /> ❑ I TANK OWNER ❑ 2.TANK OPERATOR <br /> Paradiso 10echanical Inc_ D 3 CON rRlNcTOR ❑ 4 PROPERTY OWNER <br /> ❑ 5 1)PI-IFIZ A1JTHORI2LD/k(;FNT OF'FANK OWNER <br /> Rev.(I Z,'1007) <br />