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P-1 <br />P-9 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TS — INSTALLATION <br />CERTIFICATE OF COMPLIANCE <br />(One Page per tank) <br />Page \ of <br />L FACILITY IDENTIFICATION <br />BUSINESS NAME (Same ss FAcu rrY NAME or DBA — Doing Business As) 3. <br />ONIE <br />ADDRESS (For inesi use only) 476. <br />6s` QLA- AVA - M;ZTec. <br />FACILITY ID# <br />I I. <br />I TANK D # 477. <br />IL INSTALLATION <br />(Check all that apply) <br />478. <br />The installer has been trained and certified by the tank and piping manufacturers. <br />DWti installation has been inspected and certified by a registered professional engineer having education and experience 479. <br />with underground storage tank installations. <br />480. <br />The installation has been inspected and approved by the Unified Program Agency. <br />481. <br />All work listed on the manufacturer's installation checklist has been completed. <br />482. <br />® The installer has been certified or licensed by the Contractors' State License Board. <br />The underground storage tank, any primary piping, and secondary containment was installed according to applicable 483. <br />voluntary consensus standards and written manufacturer's installation procedures. <br />Description of work being certified: <br />-7--'A) S—)i�DU�)�6LYa5� <br />E �I i S . C �1 cr <br />IaS�L�► -, � L : nre..S- ;�n.�. V SSL � <br />ill V V A <br />III. TANK OWNER/AGENT SIGNATURE <br />I certify that the infortnation provided herein is true and accurate to the best of my knowledge. <br />SIGNAT F T WNER/A <br />DATE 484 <br />NArF TANK OWNER/AGENT (print) 485. <br />TITLE OF TANK OWNER/AGENT 486 <br />UPCF (1/99) Hw(wre-c -1/2 http://www.unidoes.org Rev. 02/16/00 <br />rM <br />