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0 0 <br />TANK CLOSURE CERTIFICATION FORM <br />] <br />BUSINESS NAME CAPITOL AUTO SALES <br />PAbIUTY lD • t <br />1W <br />SITE ADDRESS <br />650 E. MINER AVENUE, STOCKTON, CALIFORNIA 95202 <br />IDS allSINESS LP <br />95202 <br />BUSINESS CITY <br />STOCKTON --m <br />TANK C.0 NAME <br />JAGENDER SINGH — <br />_ Al <br />TANK OVMERADDRESS <br />650 E. MINER AVENUE <br />YII STATE 500 aP 5011 <br />TANK OWNER CITY STOCKTON I CA 1 95202'' <br />Tank At <br />(State Tank IDs. if applicable) <br />Tank Interior <br />Atmosphere <br />Readings <br />Flammable <br />Bottom <br />Bottom <br />On examination of the tank. I certify the tank is visually free from p'oouct, sludge. scale (thin, flaky residual of tank contenbl , rinseate and debris. I further certify <br />that the Information provided herein is true and accurate to the be .t of my knowledge. <br />---.-.._ -- .—. .+,..., ne rcnncvlMG OcpCr1N 505 <br />Soil <br />50T <br />5011 <br />❑ ties ❑ No This tank previously held flammable or cam' ustible materials. <br />indicator prior to work being conducted on it a tank. <br />Camifiers tank management instructions for scrap dealer, disposeI facility, etc: <br />Certifier is a representative of the C.IPAIUA: YES ❑ NO ❑ <br />Name of CUPA/LIA <br />If certifier is other than CUPA/LIA check appropnate box below: <br />❑ Certified Industnal Hygienist (CIH) <br />Q Certified Safety Professional V SP) <br />❑ Certified Manna Chemist (CMC) <br />❑ Registered Environmental Health Specialist (RENS) <br />❑ Professional Engineer (PE) <br />❑ Class II Registered Environme.,tal Assessor <br />❑ CSLB licensed contractor (with hazardous substance certificate) <br />f yes. the lank interior abnosphere shall be re -checked with a combust <br />gas <br />