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00 <br /> INSTRUCTIONS FOR COMPLETING FOR "C": TANK INSTALLATION CERTIFICATION <br /> This form is required for piping replacements, but not piping repairs. <br /> GENERAL INSTRUCTIONS <br /> 1. Each tank system must be in compliance with the federal and state technical standards, <br /> 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 /> B. One certification is required for each tank system. This form shall be used to make the <br /> required certification. <br /> . Please type or print clearly all requested information (for printing, please use a hard point <br /> writing instrument). <br /> 5. Submit the completed certification to the appropriate Local Implementing Agency, <br /> I. INSTALLATION: DARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE <br /> INSTALLATION REQUIREMENTS ARE INET. <br /> II. CATH. THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, <br /> THAT THE INFORMATION PROVIDED IS TRUE. AND CORRECT, THE PERSON'S <br /> NAME SHOULD BE PRINTED UNDER THE SIGNATURE. <br /> INSTRUCTION FOR THE LOCAL AGENCIES <br /> The county and jurisdiction numbers are predetermined and can be obtained by calling the <br /> State Board (916) 227®4303. The facility number may be assigned by the focal agency; <br /> however,this number must be numerical and cannot contain any alphabetical characters. <br /> If the local agency prefers the State Board to assign the facility number, please leave it blank. <br /> It is the responsibility of the local agency that inspects the facility to verify the accuracy of the <br /> information. The local agency is responsible for the completion of the "local agency use only" <br /> information box. The local agency should retain the original and yellow copies. The pink <br /> copy should be retained by the tank owner. <br />