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1 <br /> tJOl1 ;�1-19 3 14 �_ FFLiM TO 12210946401-8103 P.a- <br /> XCNT"A Mrz=j=UXD SIVRAGN 27M <br /> - IXS7ALLS72/RazVn'ER/LIFER LICENSE API+SZCATZON <br /> i"UMANYM FC= <br /> pleas:+s type or print OZearly. Be alpealfic as to dates, location, and work done. <br /> Attach add=ti.on shoots as nooded. <br /> This reference forst is far Sk-W- vbo fs applying tar a license <br /> to install snd/or remove and/or line srnderg=und storage tanks in Montana. I was <br /> asked by the above appZfcant to attest to his or Ser profosslanal saxperience, and <br /> competency. I understand that Zdeensare will authorize the agpl;oant to be <br /> responsible for installation or removal or lining of facjUltiaa that store liquid <br /> petroleum or hazardous chemical products. Because these facilft.ias may bo near <br /> hoes and groundwater drialting water supplies, I recognise that MhO health and <br /> safety cf Montana's people and onviraraant are dependant on licensing only the sort <br /> campet&At and conscientfousr persona for this work. 1, therefore, understand pry <br /> responsibi2ftp fo acmpZstinQ this form accurately. <br /> my NAK V . hoseN <br /> aDaxEss: O " �'b � ++6 Lt IJ Sfi' P o <br /> 1 � 5201 <br /> My relatlonship with the applicant has been (check all that aPPIY)-t <br /> Former Mxpzayer CO rater Supervisor — Custmor ,,,_._, Friend <br /> Other (specify) `. <br /> I have knova the applicant frog to <br /> Z can personally attest to the following war* the applicant conducted with <br /> underground storage tanks: <br /> 1. anderground Storage rank F&ctIItp Mame and Addrastsrs �mxwjLL`wry 5 <br /> kttq 1 <br /> Date(s) work was conducted: 4-Zo-q 3 <br /> Deacriptfon of work conducted by applicant: <br /> Work W" �satfafactory _=sat.; actorrj explain below: <br /> i <br />