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TANK CLOSURE CEFtTIFICATICN FORM <br /> 3MNESS NAME s I '.AC:Lrv:c• 1 <br /> Tuff Boy Trailers <br /> a!—c CRESa <br /> 5151 Almondwood <br /> aus�NE'aa"`r Manteca, CA <br /> 'ANIt�HNFji`4ME six <br /> -MK=MER ACCRESS 'QI <br /> 5151 Almondwood <br /> 7ANK a A-.E Sb ZP :M <br /> Manteca, CA 195337 <br /> 11 TAS nc 'PFINF---1CVA—rtl <br /> ' <br /> Tank a Pammanle vacor Oxygen <br /> (State Tank ICI,if applicaclel Top Canter Bartvm Tap Center Baro; <br /> Tank tntenar <br /> Atmosenere 1100 gal . unleaded gas <br /> Readings <br /> I <br /> ncPT 1 �! <br /> On examination of the tank. I certify he tank is visually Ore from prvdu(¢,sludge. scale inin.laky residual of tank: r.teris),nnseate anc aeons. I further srtiy <br /> that he information provided Herein is cue and accurate to he vest of my'knowledge. <br /> I CSRT:F:ER SIGNATURE 5 US CR AF-!L!A ICN c,F _c-.TIF'!NG ZERSON srs <br /> CERTIFIER NAME(PRINT) sae Richard Thorpe Carifier is a representative of the CUP.WL:A: YES CI NC <br /> CERTIFIER TITLE sor <br /> Contractor Narme of CUPA/L!A <br /> ACCRESS 5151 Almondwood If caviller s other than CUPAIL:A emece aopmenate box neicw: <br /> c!T" Manteca, CA C Camned lndusmalHygienist(CH.) <br /> PHONE (209)239-1361 <br /> CAT-CERTIFIED sra CERTIF!CATICN TIME Q Certfied Sarin Profeess <br /> sional(CSP; <br /> v Certified Marine Cnemisi(CYIC) <br /> C Registered Environmental Health Soecalist,Rc <br /> L' Professional Engineer(PS <br /> L' Class:I Registered Environmental Assessor <br /> l3f CS'�3 iicansed ccrmacor(with M=3mcus SuostanCS CenilOtel <br /> �I "es ❑ No ,his tank prevlousn,held lammacle or ccmeusdble materials. If yes. :.ne'anK;ntenor aeneapnere snarl be re-.eraed wdm a comocs rile gas <br /> indicator prior t0 work being Conducted on the USK. <br /> Carmers:arK management instructions'or sc'ad dealer.blsposal fackty, etc: <br /> I <br /> A Cbov df'r s -art lcate snarl accamoany tre:ark:o:he rerycingidiseosal`.aciiry. <br />