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r.. <br />TANK CLOSURE CERTIFICA T ICN FORM <br />On examination of the tanx, I bill the tan¢ is visuaily'ree from product, sludge. scale (thm. AaKy residual of tanx =ntentS), rinseate and .ecus. I further �rd'y <br />that the mfonnaticn provided herein is ;rue and a=rate :a the best of my'snowtedge. <br />NAME (PRINT)Tstill Rlch rd Thorny Camfler is a representauve of the CUPAiLA: YES Q NO <br />L_ oor <br />tor I Name of CUPAJL:A <br />• uvA JJ 1 <br />CITY Lodi ' If cemfier's other than CUP.A UA caned acFroFhate box belcw: <br />PHCNCA E ( <br />Z09)368-6175 <br />G Camfied !ndustral Hygienist;C:H) <br />DAA - ..ERTIFiEZ sm CcRTiF;CATICN TIME 'J C Cartfied Safery Professional (CSP) <br />Certified Marine Chemist (C:rIC) <br />C Registered Environmental Health Soecalist (4E -:S) <br />Professional Engineer (PEI, <br />r Class it Registered Environmental Assessor <br />0S1=3 licensed cmracor (with nbZ=cus substance certific te) <br />❑ Yes ❑ No his tank prewcusry meld 9ammaoie or wmousucie materials. if yes, he tanx interior aancscnere snau de .acted wuh a ccmcus•cie gas <br />indicator pricr!o wcrk being coraucted an the tam(. <br />tank .management ns•Jllcdons .'or sCJa dealer. disposal faciity, et,: <br />A cosy of mis :zmficate snail aCCompami the !ark :o the. ecjbiinglClsCCS^I `aG try <br />aay� y <br />I 3USInE55 nriME <br />I CS ITV t ;n r <br />a <br />itC:LTY �d • � <br />Sire aCCaESS Port Wa57 IUbp.( ,P, t <br />p r <br />I <br />442 N. Air Port Way <br />+a � <br />dU51HE'aS C:tY <br />Stockton CA <br />TANK ?wKER E <br />wM <br />95 dU51sE'aS:V <br />952650° I <br />Raymond Lopez <br />K ERACCAESS <br />442 N. Air Port Way <br />AN E9 C <br />Stockton, <br />I <br />IT, AiC $tia <br />CA <br />p <br />(`95205 <br />Tanx anterior <br />Tank x <br />(State Tanx IC*, if adFiicaaie) <br />Pammacle vacor <br />Cxygen <br />`ao Comer Bottom <br />Too <br />Canter <br />� 3at•cm <br />I <br />Atniascnere <br />Readings <br />On examination of the tanx, I bill the tan¢ is visuaily'ree from product, sludge. scale (thm. AaKy residual of tanx =ntentS), rinseate and .ecus. I further �rd'y <br />that the mfonnaticn provided herein is ;rue and a=rate :a the best of my'snowtedge. <br />NAME (PRINT)Tstill Rlch rd Thorny Camfler is a representauve of the CUPAiLA: YES Q NO <br />L_ oor <br />tor I Name of CUPAJL:A <br />• uvA JJ 1 <br />CITY Lodi ' If cemfier's other than CUP.A UA caned acFroFhate box belcw: <br />PHCNCA E ( <br />Z09)368-6175 <br />G Camfied !ndustral Hygienist;C:H) <br />DAA - ..ERTIFiEZ sm CcRTiF;CATICN TIME 'J C Cartfied Safery Professional (CSP) <br />Certified Marine Chemist (C:rIC) <br />C Registered Environmental Health Soecalist (4E -:S) <br />Professional Engineer (PEI, <br />r Class it Registered Environmental Assessor <br />0S1=3 licensed cmracor (with nbZ=cus substance certific te) <br />❑ Yes ❑ No his tank prewcusry meld 9ammaoie or wmousucie materials. if yes, he tanx interior aancscnere snau de .acted wuh a ccmcus•cie gas <br />indicator pricr!o wcrk being coraucted an the tam(. <br />tank .management ns•Jllcdons .'or sCJa dealer. disposal faciity, et,: <br />A cosy of mis :zmficate snail aCCompami the !ark :o the. ecjbiinglClsCCS^I `aG try <br />