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INSTRUCTIONS FOR *PLETIN G FORM "C": TANK INSTALISION CERTIFICATION <br /> GENERAL INSTRUCTIONS <br /> 1. Each tank system must be in compliance with the federal and state technical <br /> standards, 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 /> 3. One certification is required for each tank system. This form shall be used to <br /> make the required certification. <br /> 4. Please type or print clearly all requested information (for printing, please use a <br /> hard point writing instrument), <br /> 5. Submit the completed certification to the appropriate Local Implementing Agency. <br /> i® INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE <br /> INSTALLATION REQUIREMENTS ARE MET. <br /> It. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE <br /> CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND <br /> CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE <br /> SIGNATURE. <br />