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CERTIFICATE "T°° �"66ae <br />ort srgb <br />�kT n Ca. <br />OF INSTALLATION Oeti. �aq� <br />001-SM•� <br />In compliance with part 280 of Title 40 of the Code of <br />Federal Regulations, this document may be implemented to <br />meet Subpart B, paragraph 280.2 (e), CERTIFICATION OF <br />INSTALLATION. <br />The installer must initial all sections below representing <br />that the installer has read, was cognizant of and has com- <br />pleted, as applicable, all sections of the PLASTEEL° <br />ELUTRON� Tank Installation Instructions attached hereto. <br />Return completed form to manufacturer to activate <br />warranty. <br />INSTALLATION CH-ECK—OFF <br />COMPLETION <br />SECTION <br />INITIAL <br />DATE <br />I. GENERALS <br />/ <br />INSTALLATION COMPLETION/SUPERVISOR'S SIGNATURE <br />H. VISUAL INSPECTION <br />i7 <br />�+% <br />Z Z <br />III. HANDLING <br />The responsible supervisor's signature below represents <br />WZ1j <br />IV. EXCAVATION DEPTH, BEDDING AND BACKFILL <br />that phases I through VIII were properly completed per the <br />/W44f <br />V. ANCHORING SYSTEMS <br />PLASTEEL° ELUTRONO Instal tion Instructions:' <br />INSTALLATION SITE <br />VI. TESTING <br />ADDRESS <br />ELUTRON° TANK DATA <br />The U.L. Label and serial number is on the top centerline of the <br />tank and also listed on the delivery document. <br />SIZE IN GALLONS U.L. SERIAL NUMBER <br />i <br />NAME <br />?413 AISee Z.v <br />ADDRESS <br />CIT , STATE, ZIP <br />TELEPHONE <br />VII. VENTING: JACKETED <br />�' IAMr7 <br />INSTALLATION COMPLETION/SUPERVISOR'S SIGNATURE <br />VIII. PLASTEEL`- SEALING PROCEDURES <br />i7 <br />INSTALLATION DESCRIPTION <br />The responsible supervisor's signature below represents <br />that phases I through VIII were properly completed per the <br />PLASTEEL° ELUTRONO Instal tion Instructions:' <br />INSTALLATION SITE <br />ADDRESS <br />SItNATURE DATE <br />Q <br />� y <br />CITY, STATE, ZIP <br />PRINT NAME , <br />PLASTEEL° TANK OWNER <br />YOUR PLASTEELID TANK+ MANUFACTURER IS: <br />NA�MEEj <br />NAME <br />l q Z <br />i E?e0 <br />ADDDRESSADDR <br />ESS <br />CITY, STATE, ZIP <br />CITY, STATE, ZIP <br />NO) -21 <br />SIGNATURE <br />DATE <br />TELEPHONE <br />RETURN COMPLETED FORM TO MANUFACTURER <br />TO ACTIVATE WARRANTY <br />FORM INST CERT -1193E <br />