Figure: 28 TAC §34.619(d)

o FOR SUBMITTAL            o RECORD DRAWINGS

I have reviewed these plans and
o certify that they comply with the applicable codes and standards;
          Or
o certify they were copied from sealed engineering plans and any violations of the applicable codes or standards are specifically noted on these plans.

Registered Firm’s Name
Street Address
City, State, Zip
Phone Number
     ACR- (number)

_______________________________________________
APS Licensee Signature   -   License #

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APS Printed name                                               Date