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Ca+ 31 12 11 : 38a Elit IV Contactors 12094 342 p, 2 <br /> t ' • . �a' ,��pqa, s0 sa4' i' •A 0 f' .'y ,' a ' yf nett • <br /> ! } t <br /> us e <br /> DFROG CONSOLUDATEI.I :)RM <br /> DNDF.l2ttQUND'STORAGE TANK <br /> CER CATION OF INSTA ' ,UON,, T tODMCATION <br /> p e , <br /> BUSINESS NAME(Same esFaciliry Nmae or DB 4-Doing 8usiners 4s�'" �.. <br /> BUSINESSSMADDRESS crrsr <br /> TYPB OF PROJECT( kAfflbatQ dv) .WGIZ .kiTFHd?I21ZED-T7A0}EIt.PEi2NAT <br /> ME <br /> I TANK INSTALL A t70N OR I:Et'I AGEMENT (Nt v or Dntt) ; <br /> p2 PIPING]NST:�3 C fsZ EOIJ•ORREPLAGEMENT y <br /> `p 3 S..UMY INSTAx7.AT ON 4R REPLAMCEENT <br /> :0.4 UNDER DISPENSER po=IN'SLUTATION OR REM ACENEEN7, <br /> ® 3:oTIR TL , <br /> I� E. i 17 �r n" AFTC <br /> NAME OF CONTRACT OR"WHO PER7FORHM 7.t STALLATIOMI MODIFICATION � <br /> CONTRACTORLICENSE# 4M ICC'CRRTII?ICATION 4S2e,• • <br /> B <br /> I certify thattbe infmVdeT h , , ons'baye botexi saWled: <br /> 'Ihe ieYstallerbas met. MgM t3Memts set font z in 23 CCR§2715;subdivisfons(gj anc E t <br /> ® . <br /> The undergrouhd.storage .tank;anY,l' ?3' PiFTog, gid,aay.secnndary':co�tta i:i :was anstalled'according to"appfi ble: <br /> voluntary c setstss standards and�ymmiaaufactwer's instaltafiazi instruction <br /> • :.Ad oz3 Izsted 9n tfeemaiunfactu x'sinstallation ell ldasfhp;been.ccmpteted <br /> insiallafiori.has.bepciirispedted'anila{sproeed`byse laaal aRe�acX,orif'rcgtured ty fse.Tocal agcnc3',inspected and certified <br /> a.re '' - xofessionat eer:havin ediicatioa.and ••• tvith :d Imp tank stemb'stsllations. <br /> $IGIVATUREOFTANK OWNHR"'OROWNER'SAGENt•; :D:4L�''' 484.: PHONE. 481 <br /> MUM <br /> � ��p ` �.; ��=� . <br /> CIYRTIFI&R 5 I - <br /> 4ss. GEttTEFIFIt ST X aaa <br /> C. <br /> lVA2+9E OF T7FFER'5 EMPi OYER(DBA:'";; : CERTlI'IE7t'S REL AT-IONS�i ;£O TC�NIC'OY3hIER <br /> 4l8, <br /> ti t .` p isT Ivxowx R <br /> 2-TANK-OPERATOR <br /> p to a.�Roi tiiT OvNER <br /> AL3TAORIZRD .t ENT ORTAS OWNER <br />