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TANK CLOSURE CERTIFICATION F^.R,m <br /> aU4NESS NAVE 37576 + <br /> Evelyn Pewitt Property <br /> a• <br /> 3RE ACCNEiS <br /> 2944 S. Airport Way y�s <br /> allSiNeSS CITY Stockton, CA <br /> TANK CNNEit NAME Soo <br /> Evelyn Pewitt <br /> iTANK CY ApbRESS �t — <br /> 6035 Condon Ave.TNM OwNET CITY Sp2 aTATc 56t I bV SeA <br /> J,os Angeles ICA qnnrbA <br /> Tank s Flammable Vapor Oxygen <br /> (State Tank ICs.if applicable) Top Center Bottom TopCenter Bottom <br /> Tank Interior <br /> Atmosphere <br /> Readings <br /> III r.FIRTIFICATION <br /> On examination of the tank. I Certify the tank is visually free from product sludge.scale(Nin.flaky residuat of tank Contents).rinseate and dephs-. 1 further Certify <br /> that Ne information provided herein is we and accurate to the best of my knowledge. <br /> CERTIFIER SIGNATURE I STATUS OR AFFILIATION OF CERTIFYING PERSON em i <br /> CERTIFIER NAME(PRINT) soe Martin Thorpe Certifier is a representative of the CUPAiUA: YES ❑ NO Q <br /> CERTIFIER TITLE sm <br /> Contractor Name of CUPA/UA <br /> ADORESS P.D. 135X 351 If certifier is other than CUPAJLIA thea appropriate box below: <br /> CITY Lodi CA 95241- ❑ Certllied Industrial Hygienist(CW) <br /> PHONE =(2 <br /> Certified Salary Professional(CSP) <br /> DATE CERTIFIED sae CERTIFICATION TIME ❑ <br /> ❑ Certified Marine Chemist(CNC) <br /> ❑ Registered Environmental Health Specialist(RE-iS) <br /> Q Professional Engineer(PE) <br /> ❑ Class II Registered Environmental Assessor <br /> Q; CSLB licensed Comractor(with huardous wbarw=Certificate) <br /> M Yes [31,10 This tank previously held flammable or combustible=tenets. If yes.the tank interior abrimphere shall be re-dteeked wilt a Compuspble gas <br /> indicator prior to worK being conducted on the tank. <br /> Certifier',tank management instructions for scrap dealer,disposal faalrty,etc <br /> A copy of this camficate shat)acrsmpany afe tank to the recyamydisposal facility. <br />