Form 08-4182g - Verification Of Work Experience For Certification As An Underground Storage Tank Worker Page 2
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1
2PART III.
The examination was administered by
(Testing Agency)
on
.
The examination consisted of the following categories:
Written:
1. Installation
Yes
No
2. Closure
Yes
No
3. Tank Tightness Testing
Yes
No
4. Cathodic Protection Testing
Yes
No
Please list any additional subjects examined with achieved scores or any additional statement you may consider
valuable to the evaluation of this application.
Comments:
Signed:
Title:
SEAL
State of:
Contact Telephone:
Date:
Thank you for your assistance.
PLEASE RETURN THIS FORM DIRECTLY TO:
State of Alaska
Department of Community and Economic Development
Division of Occupational Licensing
Underground Storage Tank Worker Program
P.O. Box 110806
Juneau, Alaska 99811-0806
08-4182g (Rev. 1/00)
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