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TANK CLOSURE CERTIFICATION FORM <br /> aaq� 1 y 1 <br /> CS ITV T 7 <br /> 3UStNE55 NAME 3 I RAC:LIY iCR , <br /> Tuff Boy Trailers <br /> i1TE +CCRES.i <br /> 5151 Almondwood <br /> ausNEsa cry Manteca, CA <br /> 'TNN NAME $W <br /> Tuff Boy Leasing <br /> 'ANR�NNER ACCREaa pt <br /> 5151 Almondwood <br /> "AN.:XNEP C.' WZaTA"c SO' ::a <br /> Manteca, I CA 95337 <br /> 11 TANK (71 nG 'PEria <br /> Tank il Fiammacle•/acor Cxygen <br /> (State Tank ICS,if applicaole) Too Canter Eottom Top Canter Bottom <br /> Tank Interior <br /> Atmosphere 1100 gal . unleaded gas <br /> Readings <br /> T 1 T1 <br /> On examination of;he tank. I artity !an dsu dud.sludge.scale(thin,laky residual of tank ccntents),dnseate and cecns. I further srdy <br /> that the intonnatidn Provided her is' d accts a!o t of my knowledge. <br /> CERTIFIER SIGNATURE I STATUS CR AFFILIATION OF CERTIF'ING-HRSCN sos <br /> CERTIFIER NAME(PRIN I ..ae Richard Thor a erJfier is a representative of the CUPAJLIA. YES Q NC CR <br /> CERTIFIER TITLE stir <br /> Contractor Name of CUPY'LIA <br /> AOCRESS 5151 A raon woo <br /> It cem8er�,s other than CUPAL:A=ecc apprnpnate cox Delcw: <br /> Clrr Manteca, CA <br /> PHONE (209)239-1361 Q Certified Industrial Hygienist(C:H) <br /> CA,cc CERTIFIED soe CERTIFiCATICN TIME Q Certified Safety Professional(CSP) <br /> •"��!! Q Certified Manne Chemist(C..MC) <br /> /']/Z / �� �t w` ❑ Registered Environmental Health Specalist(RE"S) <br /> L. • Q Professional Engineer(PEj <br /> ❑ Class.I Registered Environmental Assessor <br /> CSLB lic:nsed contractor(wdh hazarccus suoscanc arnfiate) <br /> �I Yes Q No This tank previously held 9ammaele or comoust ble materials. ifyes.the tank interor atmosphere shall he re-.necxea month a comousDDle gas <br /> indicator prior to work tieing odnducted on the tank. <br /> Camfiers tank management instructions;mr scrap dealer,disposal faeitty,etc: <br /> A Cocy of this�srtincate snarl accamoany the lark to the rec/Czngidiscosal facny. <br />