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d <br /> TANK CLOSURE CERTIFICATION FORM <br /> R� y <br /> F6 <br /> BUSINESS VAMC 1 :AC:LTY i0• 1 <br /> Central California Traction Co. <br /> sn'E +CCRESS rM <br /> 1645 Cherokee Rd. <br /> auslNesscm Stockton, CA <br /> TANK C- N .WME 3N <br /> Central California Traction Co. <br /> TANK-MMER AGGRESS 30r <br /> 1645 Cherokee Rd. <br /> TANK OWNER C:Pr SM STATE 50] ❑R 5W <br /> Stockton, I CA 95205 <br /> Tank S Rammacle'/acor Cxygen <br /> (State Tank IC9, d 3tivicaolel Top Canter Sottcm Top Center Bottom <br /> Tank Interior <br /> Atmosonerere <br /> Read coo3 <br /> 04 r <br /> RT 7 r <br /> On examination of Me tank,I recti anK is om produc.stodge.scale(thin,flaky residual of tank cements),rinseate and cleans. I huther xrtrfy <br /> that the information prowtleo h i e an acor t ;he gest of my'snowledge. <br /> CERTIFIER SIGNATURESTATUS CR AFFIUATICN CF CERTFrING PSRSCN �If sps <br /> CERTIFIER NAME(PRINT) sos 1C ar or Camfier is a representative of the CUPA/L;A: YES ❑ NO lq <br /> CERTIFIER TrfLE 307 <br /> Name of CUPA/LA t <br /> ACCRESS <br /> C:T! If certifier is other than CUPA(LIA check appropriate hdx bebw: 4 <br /> PHONE Tndj CAQ Camfied Inowinal Hygienist(C:H) } <br /> OATE CERTIFI • sm CERTIFICATION TIME ❑ Certifier:Safety Professional(CSP) } <br /> � Q Registered <br /> Monne Chemist(CMC) <br /> r ��— ❑ Reggistered'environmental Health Specalist(RE='.S) # <br /> i <br /> � ❑ Professional engineer(PE) , <br /> Cass II Registered Environmental Assessor <br /> CSLS licensed contractor(with nazardcus substance certificate) <br /> "es ❑No This tank previousy held laminate or comousable materials. it yes.the tank interior atmosphere shall be t --hexed wdh a comousuple gas <br /> indicator prior to werK being conduced on the tank. <br /> Cartlfiers tanK management instructions;for scrap dealer,disposal faelity,etc: <br /> A copy of this cemficate shall accompany the!ank to the reaycing/disoosal faeiity. <br /> DTSC 8022A(d/97) " <br /> EPA 8700-22 - - - '- - - Green: TRANSPORTER RETAINS- <br />