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Apr 19 13 11 : 43a E1it IV Contactors 1209461&342 p, l <br /> M Ff 10 <br /> UNIT=PROD CONSOLIDATED 1 JIM <br /> UNDERGROUND STORAGE TANK <br /> CER CATION OF WSTALLA,TTQN f r 10DM6Xw#13 <br /> KI 1r1=uhwo11Lrry <br /> FACR ITY ID0 wm+i1 Use(hrly) <br /> BU NAME'(Same asFacey NameorDB,4—Doig BucinpxAs) a. <br /> ry <br /> BusAl Mgg <br /> - <br /> �. e � <br /> TYPE ORPROJECT(Check-a#4wAWij as3a. WO U ),UTHORIZED UNDER PERMIT T asap. <br /> Q I.TANK INSTALLATION OR REPLACEMENT -(Nu ni v or Da ) <br /> Q 2."PIPING INSTALLATIOtr'0R REPLACEMENT <br /> [1:3.SUMP INSTALLATION OR REPLACEMENT tf� <br /> Q:4-UNDER DISPENSER CONTAR�iT 3.OINSTALLATION OR RFPLACI IVT ' .r 1 , <br /> THEIt'. . <br /> DESCRIPTION OF WORK BEING CERTiFIF,D: as3� <br /> 44 <br /> ^f <br /> NAME OF C0 R P RMED ILLATION/MODIFICATION — - 492a <br /> CONTRACTOR SE# ICC' TIFICATION''#— 42c <br /> _ 2=1125titl�iY <br /> X certify that the information provi41e8 herein is tree,accurate,and Yh$t tffie following C o ditions have been satisned: . <br /> The installer has met the requirements set fortli in 23 CCR§2715,subdivisions(g)and <br /> • . The underground storage tank, MY Ply pig, .and any secondary contaimx'�:n was installed according to applicable <br /> voluntary consensus standards and any.manufac2urer's written installation instrtj ions. _. <br /> Allwork listed in the,manufactu Ws•uxstallaraon checklist has been completed <br /> • The installation has been inspectedand approved by the localagency,or ifrequired by Ile local agency,inspected and certified <br /> by a're feSSional.en ' eer having education and experience with )ragetanksystem installations.: <br /> SIGNATURE TAMC O OR OWNER S AGENT <br /> DATF� aaa' PHONE M <br /> :.CERT 'S NAMIr(print) ass. <br /> _.- CERTTPIER'S TFII E a <br /> NAME OF CERTIFIER'S EMPLOYER(DBA} 49R. CER'IIFIER.'S RELATIONS)M 9 O TANKtO,WNER <br /> J� 7 oss <br /> .Z( "`! J r• �a rl1.�L( C� j,// : tea C3.I.TANKOWNER 1 2.TX-�K-OPERATOR <br /> CJ.3:CONTRA GTO$ .' 4.PROPERTY OWNER <br /> Q S.07MRAUTHORIZE)). :PENTOFTANKOWNER <br /> } " LJPaCF C15T-C12ev.{1?J'.007j�1/2 <br /> wwwjnddacv,011 <br />