Laserfiche WebLink
Apr 30 10 02: 10p Elite V Contactors 12094616342 `. P. 1 <br /> Ann <br /> .... iJ�YIC.[`•.i••.DT .®lr1Z.'i.Ird�.OINTs®i.r7.iiliArrl�'�ol�M (.J <br /> UNDERGROUND STORAGE T_ hZ+: , <br /> :.fQrie.formperpro�ect}.:�._........ : _ <br /> h <br /> _ <br /> • ,: ,. <br /> �• fig. <br /> .. ....:t..x.e.F+n .. .. axal'x nu• '-�w:.. .... x .J.,._ ' k :...: <br /> Via°• ,=n •c <br /> 7. <br /> t�s� y1 <br /> FACILITY LDS <br /> B ' INESS NAME(Sank ar .orlliry AlmFac or DB.4-Doing Busi��exs _ 3 <br /> B 'ESSStTEADDRESyll:w <br /> S <br /> �+ <br /> ... .. G OF-PROJECT.(CheeicF'all than IIDDII1 - .. - '4mb.. <br /> vpa.. WORIi11T7TTiOR.IZm.UNDERPERJvQ1' <br /> TANK'XNSTALLATION OR RE?LACIIi+1 NT: " .(Number or Dai) <br /> D( 2.FIPING JNSTALLAT ION OR'REELACE ENT, <br /> Q..3.SMV U%%'TALLATION.OR REPL�AC�i <br /> . •.. �: 4.UJ3DERALSPENSER�ONTAINIvv1£ttdT'INSTALLATTONORIREPL,AGE�NT r . <br /> ESCRLPTION-OF—WORI*.EEiNGCERTII�EU�— — - -- --- — � — _ <br /> � -� <br /> NAME4 COtvTRACLOR4t�FiOPERFDRA�DINSTAL.LAMIXV DMCA,n0N <br /> CONTRACT OR•Ll a� ICC CERMCAITONR ` <br /> T certifp that the infor�atioe gro��ieled herein is-trneaccuz ate,and that the following conditions 1iae�e been satisfied: . <br /> '„'.�•;.The�iustaIIer;has.-Inctth . : •. •• . - <br /> e-z�ture�ents set forth mo:13 CCR°§27I5;subdiotsions(r�.end{h�:'".•..', . . . <br /> The undergormd Storage,bnk,'-any.PSS'Piping; anti:any secondary containnleat;svas installed'ac:ording to appli bte <br /> voltmtary.concM* c=sfiaudards-amd'any maaufactt 's v�en mstallaiionznslriictions <br /> •: ..ASI work listed in the manufacitm t''s•iastallation chec3disthas beon:campleted <br /> ®:- Tlie:installatican hasbee�msexted ani:approV,;dythr,loeat.aDency,`at ifregiiueaT'.b3t.tfie local a;enc3',inspected and cified <br /> - <br /> b .a ed fusional en" aei.ha'' educatiba.and experience vvidi'tffi imd sto .a tank stem•msIwh6onS. <br /> SIGNi4 OF TANK OWNEPWR OWNERSAGEW:._' DA PHONE. <br /> - .. 'S 3 <br /> p1AA4E OF CERTIFTiR'5 EMPLOYER(DBA):: :. ° ::.CEECI LFLh�L:S.tEC:4TIONSHIP,TO T/M'OWNER '�' <br /> ' <br /> TPt!7g t7t!Ett'A7�DR. <br /> s (� <br /> r y� fi `3.. R:.:..:•.i®'4.P]LOPERTY OWNER <br /> § :: _'AT3�F30RIZFD'AGEEt��'T OF-TANL 6wNER' <br /> O <br /> r vrcA "�C 952Q5 aa«� <br />