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Tank and Secondary Containment <br />Assessment Document <br />This document was prepared for: <br />Oil Stop <br />301 W. Kettleman Lane <br />Lodi CA 95240 <br />Tank/system identification: <br />Used Motor Oil Storage Tank and Ancillary Conveyance System <br />Tank S/N A-634327, Lube Cube Manufactured by Containment Solutions <br />Date of inspection(s)/assessment: <br />January 17, 2014 <br />his report consists of 15 pages. <br />I certify under penalty of law that this document and all attachments were prepared under my <br />direction or supervision in accordance with a system designed to assure that qualified <br />personnel properly gather and evaluate the information submitted. Based on my inquiry of the <br />person or persons who mange the system, or those persons directly responsible for gathering <br />he information, the information submitted is, to be the best of my knowledge and belief, true, <br />accurate, and complete. I am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment for knowing violations. <br />Engineer's name: Jeffrey K. Belwood <br />License Number: M-29705 <br />License Type: Mechanical <br />ddress of engineer: 9375 Pioneer Circle, Stockton, CA 95212 <br />QQ;CIf1~SSJ <br />029705 1 <br />4 <br />wx�Qyb/3o ZGt4- <br />�r� RECEIVED <br />C <br />FEB 2 4 2014 <br />Date stamped/signed: January 28,2014 ENVIRONMENTAL <br />ncMLt rt UCrAM I MtN 1 <br />