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Oct 31 12 11 : 05a Elit IV Contactors 12094 6342 p. 2 <br /> -xJNWJrED.-PROGRAM Ct3NSOL DATED F I RM ' <br /> UNDERCR()UNA STORAGE T1�tVJ's <br /> C RTD CATION OF E SiALLAT 610 +�Dl[TZ'.'CATION <br /> :{(hie fci� <br /> v . <br /> BT IMMS IJAME(Same as FacilPryName'orDB4-DaixgBusuaess�?s) <br /> LODE <br /> BUSDNMS SrrE ADDRESS 103• CTry. <br /> 145 <br /> (C <br /> TYPE OP PRO►FCF' heck Frhat •:- <br /> aYv)' WOI { .4IT1TiORiZED-UNDER PERMIT .` <br /> r0•.1.TANK:INSTALLA.TION.•ORREPLACEAMNT <br /> (�2 PIPIIVG INSTAL ATOMA REPLACEMENT <br /> 4:LIIQAEIiTlSSPl NM'CQNTAIlQAnFN 7AZST-kLLA 70N ORR RRL4C�vIEidZ e <br /> SOT OTfiER •.r �c <br /> _;.:...�.:..__.�-.�1PSCIiIP�YOIti!OE-WL?R�BFtAiG.^CHER :-.�.,._�_�:......,�-�'�:.;_--� -- -_ - _..:4�5• <br /> + 1.C. Lua��' !� `.1 J, '�u�e.w�� <br /> .. <br /> CZA <br /> ��tCcCE Ui'l&lci'k; ci d � : t : .tt t_cle� rcc <br /> { CSS Ji(In <br /> Wit' <br /> �! <br /> I!tA_ME OF COPTIItACTOR WfiO PEPFOR)ED INSTAL[.An(7N:)'ANODMCATTUx...: 4 <br /> CONTRAMR LICENSE 1 ICG'CERT KATION# rise.. <br /> I certfty that'the infd ' n provided herefn is tme,acaq*e,and tea#the followmg a iali6ion&have beesis satisfied: . <br /> :The mtaller aha mate,Jse. is set,orth m' 3 CCR§2715;:si ibdzvisiorss{gj and{I <br /> :.:. ne undmpouod,storage tans];, any. primp P?cpnng, and any..secondary':contai��n =was,installed according to applicable+ <br /> 'voluntary consenscts standards-and ary aft='.svtitten iristaIlatiosi`iush actions:.` <br /> ® .A11woxk�ist�d in the.n=ufactcttlr'S•iAslallahon checiclsst}ias berms completed. <br /> • <br /> �, Ttie mstallation.3�as been.irisQected a�t:approm a by t11e lot I agency,or rerluiied'Ix� c�]peal ageucy,insliec ed and certified <br /> b a-ie 'stered'`rofesWonal en " ear haeduit�atioa and a ence with.undeii- un 3: ,gra tank instaUations. <br /> 5IGNATIYRE OF TANK OWNER OR OWNER'S AGENT DATEa&0 PHpNE asa. <br /> 4' d. VKI <br /> CERTMM'S Tact. CERR Ii R s 1TLE I }} 71 <br /> NANII:OF TIFIER'S EMPLOYER(DBA);' ass.' CERTI 'SRELAMNSI TG I'O•TANK'OWIdI~3t' ' <br /> �...�.1:�`t:'.% � �(;J;'`1�"1C:CT�"l'�j f.•�'��. �. • D i.a�ax..owrrlrR �,'2:TAHIC'OPERAT'UIL - <br /> '... <br /> 7-FF#(AMMM <br /> [3 5.OTHEE2 AI)TIiORI7.EY?: aENT OF TANK CiWNFR <br /> a en•� W F_.�....+a'r ft < r .h .r • � f'a r. <br />