Laserfiche WebLink
Oct 15 10 07:09a <br />Elite IV Contactors <br />... .10 . . I . <br />12094616342 P.1 <br />LINUIED PROGRAM CONSOUDATED FORA <br />UNDERGROUND STORAGE TANK <br />CERTIFICATION OF )INON / MODIFICApf )J115 <br />2010 <br />FACE= ED # (Agency Use 0*) <br />BUZ. <br />N r—c-F—fir <br />I JI <br />AWRESS j <br />BUSINESS <br />i,4 <br />4m' WORKAUTHORMED. <br />YPEOFPROJECT. Check _L)jg_a= UNDER.PMUv= <br />❑ i.TANK iNsTALLATjoN OR REPLAcBeNT: .(Numb=" Dam): <br />:PPJNGINSTALLATION .OKREPLACMJENT <br />SUW INSTALL OR REPLACEDdENT <br />0 msPENsER coNTAaaaENT iNsTALLA-nm OR REPLAcEmENT- <br />D� T1 MN. WORK BEBT?-CERTIF�_1. <br />v <br />FEE <br />ON/MODMCAMN 482L <br />mr*-ammil"1111 A FFMW <br />1111�'Jj� <br />ff) WS ArW, M 1 11 �i <br />I certify that the -Wormfionjpro-trided herein is true, accurate, and that the following conditions have been satisfied: <br />Ae. The installerhis met -the requirements set forth in 23 CCR .§ 77151 subdivisiong (g) and (b). <br />• The' undeTgrouhd storage tank, any. pr�'.pipin& and any !was installed' according to applicable <br />voIuniary cousenm-standards-aud any.manufhctu=`s written .==== <br />• A.Twork listed in the manufacturer's -installation checklist -has been completed. :- <br />Th. einstallation.hai b6mn and, .iipprbved Mrihe local ortif reqpiried by the local agency, inspected and certified <br />4ency, <br />bmaxegaisteredp essional engineerhaving education and T�p�mence with uugerE2and tD, tank instalmons. <br />_qL . . I R %, 4V <br />TANK OWNER'SAGENT.. DA PHONE /5rm 9R. <br />j <br />• <br />C-. <br />$ "495. CERIWIM' .496. <br />NAA9E OF CER D J A <br />ENIPLbTg(DSA)'. 438-j cEmumvs R9.L.A7TONsHW.T0TANK OWNER 489.1 <br />