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INSTRUCTIONS FOR COMPLE FORM "C": TANK INSTALLATION LLAT ION C KATION <br /> This farm is required for piping replacements, but not piping repairs. <br /> GENERAL INSTRUCTIONS <br /> 1. Each tank system roust be incompliance with the federal and state technical standards, <br /> contained in law and regulations, for tank and piping installation. <br /> 2. This certification shall be completed by either the UST owner or representative. <br /> . One certification is required for each tank system. This form shall be used to make the <br /> required certification, <br /> 4. Please type or print clearly all requested information (for printing, please use a hard point <br /> writing instrument). <br /> . Submit the completed certification to the appropriate Local Implementing Agency, <br /> 1, INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE TH T THE <br /> INSTALLATION REQUIREMENTS ARE MET. <br /> It. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, <br /> THAT THE INFORMATION OVIDE IS TRUE AND CORRECT. THE ERSO ' <br /> NAME SHOULD BE PRINTED UNDER THE SIGNATURE. <br /> INSTRUCTION FOR THE LOCAL AGENCIES <br /> The county and jurisdiction numbers are predetermined and can be obtained by calling the <br /> Mate Board ( 1 ) 227-4303. The facility number may be assigned by the local agency; <br /> however,this number must be numerical and cannot contain any alphabetical characters. <br /> If the local agency prefers the Mate Board to assign the facility number, please leave it blank. <br /> It is the responsibility of the local agency that inspects the facility to verify the accuracy of the <br /> information. The local agency is responsible for the completion of the "local agency use only" <br /> information boa . The local agency should retain the original and yellow copies. The pink <br /> copy should be retained by the tank owner, <br />