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NOW <br /> TANK CLOSURE CERTIFICATICN FORM <br /> C3 IrI T' I(- ;i y I :ACtaviC• <br /> RUSINEW NAME <br /> San Tomo Partners :a <br /> >:c ALCAEss <br /> 11291 N. Alpine Rd. <br /> .pg dU51NE°s�9 '7e <br /> 212 <br /> 7TANK <br /> Stockton CA sod.NNEA NAMESan Tomo Partners nflER A"REs'a <br /> 11291 N. Alpine Rd. saA;E <br /> TANK.-'^ERQ;r I a'CA F95212 <br /> Stockton, <br /> II T1,� f r'�c c nG CxySen <br /> Tank i Flammable,incr <br /> (State Tank ICS,if apciicaolel Tco Center - attom I Top �I <br /> Center 3ottcm <br /> Tank Interior , <br /> Atmasdnere6 ,000 gal . Aviation Gasi. <br /> Readings I I <br /> t4 ,000 gal . Jet Fuel <br /> On examination of me tank,I verify the WK,s visuairy`tee from?rddua.sludge.scale;thin.9aky residual of tank contens;,nnsea[e Pori deans. I(anter xr.'+ <br /> that the nformaticn Provided herein,s ide and aC •rate to the:est of my'mowiedge. - , <br /> a US:R AFr L!A7CN CF CER7F(ING FERSCN <br /> CERTIFIER SIGNATURE LX <br /> � Cet IF'ER NAME'PRINT) sae Ri chart] Thnrna <br /> Cardfier Is a representative of the CUP•YLA: '(ES C NC <br /> CERTIFIER TITLE or I Name of CUF.AJUA <br /> Contractor <br /> ACCR''^ p 0 Box 357 If cemper'.s other than CUL: <br /> FA� A cm <br /> eCr apccnare box Ce!cw: <br /> C;T1 Lodi CA 95241-0357 ❑ Cartifiec!ndusinal l-ygten'se ICIH) <br /> PMCNE 209 368-6175 ❑ Calcified Safety Professional lC,SP) <br /> OA ^=RTIFiED sae pERTIFICATIGN TIME <br /> -� ❑ Carof[ed Manne Chernm (CMC) <br /> C <br /> Registered Enviranmentai Health Sdecatist(RES) <br /> ❑ Professional Engineer(PE' . <br /> Cass it Registered Environmental Assessor <br /> -_SLSlicensed Omriaor(with hazamous suostance ceraficatel i <br /> ❑ <br /> with camousPole las <br /> yes Q NO This tank prevI0U5ry held iammaole or comousabie matenals. If yes.the tank itterer armescnere Wall be re­.:eckea a <br /> meloatcr pnor to work being danduGed on he tank. <br /> i Campers tank management,,1 tID dons`or sc❑deacec disposal faeiity,etc: <br /> I <br /> II <br /> � I <br /> A oocy :f ails M rlfl to strra <br /> ill-it acmpany:he tank;o z e regafng,'discesai:Polity. <br />