Laserfiche WebLink
STATE OF CALIFORMA <br />STATE WATER RESOURCES CONTROL BOARD <br />CERTIFICATION OF COMPLIANCE <br />O• ••'! <br />MC vi I U q:1 9411M*14:7,11 0A 9:1;[#] V <br />W.- <br />CITY COUNTY <br />11. INSTALLATION (mark all that apply): <br />F—] The installer has been certified by the tank and piping manufacturers. <br />❑ The installation has been inspected and certified by a registered professional engineer. <br />The installation has been inspected and approved by the implementing agency. <br />All work listed on the manufacturer's installation checklist has been completed. <br />The installation Contractor has been certified or licensed by the Contractors State License Board. <br />❑ Another method was used as allowed by the implementing agency. (Please specify.) <br />I �lI I IN I ITIT I ''T I ''T III! I 1 1!11 111! IF! 1111 1 <br />Tank Owner/Agent <br />Date <br />Print Name Phone <br />STATE COLI JURISDICTION # FACILITY # TANK # <br />TANK I.D. # FT -1 I I I I I I I I I I T -7m <br />FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORM A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FOR0035C7 <br />