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TANK CLOSURE CERTIFICATION FORM <br /> lata � y <br /> W91Me5E IIYIA _ 3 IIHSLlM1O• 1 <br /> John Taylor Fertilizer (Stockton Facility) <br /> ire•GG E55 <br /> 1819 South Argonaut, Stockton,CA <br /> wsasssarr Stockton CA a <br /> TANK CV.WA neva m <br /> John Taylor Fertilizer (Stockton Facility) i <br /> .u.x cnwA.00As a °O1 <br /> 1841 West Elkhorn Blvd. <br /> iANI(CAMOIGr � ��� S13 � � <br /> Rio Linda Ca 95851 <br /> 11 TANK ;LQ&a=PQ;;I1jATIr1N <br /> Tam s Rammaate vapor Oxygen <br /> (State Tatar ICA,if ap0cable) Top Center eattam m <br /> Top Center sam <br /> Tank lnargr <br /> Atmosphere <br /> Readings <br /> III r.Fq'nF1rATIQN <br /> on examination of the tank.I certify the tank is viwalry,free from preoua.sluage.sale phin."residual of tank contwns).Brain a and 4UM 1 further Gantry, <br /> that the information provided herein is tae and accurate to the test of my knowledge. <br /> CERTIFIER SIGNATURE STATUS OR AFFILIATION OF CERTIFYING PSRSON s.n <br /> CERTIFIER NAME(PRIM'( sot Carbftr is a repreasmag"of the CUPA/UA YES ❑ NO Q <br /> CERTIFIER TITLE sr <br /> Name of CUPM(JA <br /> ADDRESS <br /> N cerdAw is oNw Nan CUPMLIA dredr apprepllse Dox below: <br /> CITY ❑ CardAed Industrial Hyperion(CENT <br /> PHONE E3 CerdAed Safety Praleaslanal(CSP) <br /> DATE CERTIFIED rot CERTIFICATION TIME <br /> ❑ Carolled Marine Chwrm[(C34q <br /> ❑ Registered Enuiramnanal Health SpacaWt(REHS) . <br /> Cl Prpaeaanal EngNeer(PQ <br /> ❑ Class It Registered EmaraenrrW Assa ksr <br /> ❑ CSW licensed contractor(wet hazardous srmanrke cartlAcatal <br /> ❑Yu ❑No This tank previously tad IlammabN or comousible materials. if yes.IM tank Trawler atmosphere stall be re-drsUad win a comausaale gas , <br /> ddlatar prior m work being roMucted an that tank. <br /> CariAers tank management Instructions for tarp deer.disposr tachy,rc <br /> 1 <br /> A Way of NIe antArate shag awmpwy Is;tank a the recyGkgidapaer acYly. <br />