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10127/2011 23:32 7635311801 DEANS TANK INC PAGE 04 <br /> a kalfication: <br /> -'Tank Owner <br /> #,4w*that the Ml Wm don&&TNW is a antgo and cch piste to the best of my knowledge;that lndmNe bra of tanked fig,and . <br /> d pensers Is eaooraDnp'to IbtMn.R.ch.7150.aubps:0100 end D205,rnewing'saoandary containment of now and repbewrant <br /> talks,piping,and dlsperrsera;and Nrat ad tanks end plph�y hays riNease detecdlon acooidlnA b Il�nn.l�di. 1150.sutra.0�0 Ib <br /> d��{340(For owners purchasH►a tanks eRar March 1,2006,only)l certify that all tank operators,Includlrrq Mssaes,haus rated this <br /> rhapterand have sulllF�ent knowMd�ps'Irr,the operafloa and neMtesnance of undslpround stara�tank ayatem� " <br /> Nrme•of owner or, ----��. <br /> oWne' es authertzed represent".(print): M Ir 6P AIV�Z E <br /> r7 l <br /> Tale: Dab: <br /> j <br /> .Signature• <br /> T�nk.Contmctor <br /> •.I far&that all work was performed as.specified by the manufacturer's irtstriscW that aN wm1lc was perlbbm®d according b the <br /> a/jp6oable codes of prgcBi:e!n Mjnn.R.'ch.,7150,.,sybp.0205;that all work�vas parform�d acco�lrrg fo appQcse•stete end rederal <br /> r+�qulatlons,lndud/ng Ehle chapter,and that/em In oompAanoe Woh cc idsctor carMation requimments imposed by Minn;R.cli. <br /> 7150. <br /> MPGA auWvWor Tank contractor or <br /> o alts during tank contractors audwrlmd <br /> rk(printi: /Ir�E?`/ representative.(print): .-Ad /S T wk^ !✓C- <br /> y0/ r Data' <br /> .Too, Title: <br /> 4nalure: Signature: T <br /> MPCA �. <br /> 9up®N� o #: - Contractor-* <br /> j <br /> i <br /> j <br /> i • <br /> I; <br /> t-1-04 <br />