|
<br />e
<br />
<br />e
<br />
<br />)
<br />)
<br />
<br />I Rrlify Ih:lllhis inslall:llion will bt complrled in accordance wilh Ihe plans and specilications contained herein and in compliancr with all
<br />applicablr SafrlY Rules of Ihe LP.Cas Division, all applicable stalutes or Ihe Stale or Texas and any Commillion Ordrr (where applicablr),
<br />whirh may brrf\lrrrd pertaining 10 Ihh installalion.1 understand Ihal any changra regarding Ihe tank sile and localion or modificalion 01 Ihr
<br />Lp.gal inllallalion will nrcruitale ~.ubmhlion 01 planllmmedialely. LP.gal conLainer(l) will nOI bt inSLalled or Iilled wilh gas wilhout
<br />rlCprl'lI aUlhorizalion Irom Ihe RallrOlld Commiuion LP.Ca. Division or unlil luch time lenLalive approval hu bten granled, I.also
<br />undrmand non.compliance may re.ult in my company bting .ubjecled 10 adminillnlive enror<<ment proceedings and/or criminal rjnes.
<br />undtr StClion. 1I!.I61 Ihrough 115,.252 or Chapler II! or the Teu. Nalural:Rrsour<<. Code.
<br />
<br />~ O~~53
<br />q-~';B9
<br />
<br />
<br />rnlnpany N~ml':
<br />Addrl'lI:
<br />Trlrphnnr:
<br />('.onlaCI Prrsonl.l:
<br />
<br />Au.horiucf, Sllna'ur~ Dal~
<br />II ,hI.{ IIppfirD,i,m ('onurn,l Ih,. in~IDlllllion 01 D SIDI;ontJrY LP'gDS insIDII.,ion ullO,ooo g.lIo~s or ,"ort, aggrtgDIt rDpaei,y, ,h,.n ,h,.
<br />lollow;",( appfi,.., A Is!). I errlil,'lhal raeh rral properlY owner, a. delCribtd in Seclion9.28(b)or Ihe LP.Cas Salrly Rull'I has rreeivrd nOlieI' of
<br />Ihi~ ..P'RIS i,lIlallalion nn LI'G Form SOO(al, I undrrstand Ihal lailure 10 do so may result in Ihr convrninp; of a publichl'arinR undrr Sf'el;n"
<br />9.2RC.11 01 Ihl' LP.Cas Sall'l,' Rull's!
<br />
<br />~~. O~~~~
<br />___ 9-(1- ~9'
<br />
<br />AUlhorized Sllnilur~ Dil~
<br />I II..el:.,1' ulld..r P<<'nahit's "rrseribr~ in 591.143 01 IhrTrxu Nalural Resourcrs Cod;' Ihall am aUlhorilrd 10 make Ihis allidll\'i:. Ih:1I II ...".
<br />pr..":,,.-d by In" or undl'r my supervision and direclion, and Ihal dala and lacu slalrd hrrrin arr Irur, eorrrel and complrll', 10 Ihl' brSI 01 m)'
<br />knnwll'dlCt'. I allO undl'r51and Ihal any ehanp;rs rrgardinJl; Ihr lank Sill' and localion or modilicalion of Ihe Lp.p;as syslrm inslallalinil ",ill
<br />nrc'..uiml!,'II'suhmillion ollllans im'ml'dialrly. I also undrrstand Ihal Ihr Lp.Itll.lankl.) .ystem. and al>plianers arl' 10 br inslalll'd "....11' 11\'
<br />prnulIs. firms and rnrpor;lIionlliccnSl'd wilh Ihl' Railroad Commission 01 Trxa. und!'r Chaplrr 113.08201 Ihl' Trxas Nalural Rl'sourrrs ,<.",od...
<br />
<br />
<br />'~.
<br />
<br />, , AUlhorl1ed Slln.luff
<br />, I
<br />List of Generallnstallen: .
<br />(PrOl.id,. NtHII', Adtl,tlJ. IIntl r,ltpholl' No. ol'i,.,nstd ;nslllllt'SlUht,t .pp/irdlt. II '~,O,t IIp.rt is nudrd, i111l1rh SlIpplrmtnlll/s/,u/J
<br />
<br />Engineeri.)/ Archilec~(.) .. '
<br />Company Namr:
<br />Address:
<br />Telephone:
<br />Contact Prrsonl'):
<br />
<br />(),u,~ 5" 3
<br />Lie. No.
<br />,'1- 8- 89
<br />
<br />D,,~
<br />
<br />rn.npany Na'7ll':
<br />Add,rss,
<br />
<br />Tl'I..phun..:
<br />OInlarl Prnllnls):
<br />
<br />General Contractori.)
<br />., . Company Name:
<br />Address:
<br />Telephone:
<br />Contacl Personls):
<br />
<br />Company Namr:
<br />Add rl'u:
<br />Tl'll'phnnr:
<br />Conl;!el Pe,sonls):
<br />
<br />Mechanical Subconlractori.)
<br />(Hta/ingIAC, Plumbing, Equipmml supp/;t,s)
<br />Company Name:
<br />Add,ess:
<br />Telrphone:
<br />Contact Personl'):
<br />
<br />,"
<br />
<br />r.ompany Namr:
<br />Addrrss:
<br />Ttlrphone:
<br />Conlacl Prnonls):
<br />
<br />Company Name:
<br />Add,eis:
<br />Telrphone:
<br />Contact Person(s):
<br />
<br />(CONTINUED ON BACK)
<br />
<br />LPC form ~OO. ~.Rr ,
<br />
<br />X-27
<br />
|