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FS-02-04 17:30 FROHLEEMAN ROESSELEN 916-839-1168 T-746 P.WIT F-539 <br /> ar �r <br /> TANK CLOSURE CERTIFICATION FORM <br /> BllslnEs614Mp <br /> S FxG4TYge � <br /> srQG � �Q G��L 8.�.LL <br /> 76 y y N• �QS�sGC y 1ANc <br /> p,rnNREs ory S7VC/e TD/✓ rW RUSIN, wqv <br /> IN <br /> T�Nn C�•irEi MM yy��. <br /> ••nR eymE?o Aug p, <br /> S,BL 3707 fG iA/rS.f k",* <br /> rMk Lyn"CITY 3,ften 7 nTa cal IF t;. <br /> G,es4-MeNT� � 9SSS� <br /> Tank 1 Flamma a vapor usygen <br /> (Stens Telre Int,if appllmtilal Top Canter 13040M Tap Cerner I smwm <br /> Tank Interior <br /> Atxm Spne/e <br /> Rpaings <br /> I <br /> On examination of me tank.I comfy the tank a vpsaaT 1116,111114111%pfaaYa.Mugge.Sala(min,haKy reslaual of lank canimts),nnseste ana aeons. I havrer candy <br /> tR�t the mrormatWn provraea nsxain a we ana saalrste m ore trasr pf my knagNega. <br /> CERTIFIER SIGNATURE S.ATU9 CR AF ILIAMON O CERTIFYING PS.RSON is <br /> CERTIFIER NAME(PRI eta Cen)hor is a nprownmave of ase CUPMIA: YEs ❑ NO Q <br /> CERTIFIER TITLE est <br /> Nam!of CUPAA.IA <br /> ApONEbs If cartflar is alh4r man CUPvlat9rArh1A <br /> CITY appropriate Box oahkr: <br /> PHONE ❑ Car" ridwar al""mien(CIM <br /> A C R IFI ssK CERT( (CATION TIME ❑ Ca Lift safer,Ftweulanol tcw) <br /> ❑ Gained laante CnamlN(CALM <br /> ❑ RcVSM O EfNironmdum Realm Spedai'wt(RE}IS) <br /> Q prob"Iarlal enalneer(PE) <br /> ❑ Class a Ragiteemd tmmifbnplenml Ameasu <br /> C] CELE dem <br /> es aonpamr 1WIm naxaraaus smo <br /> unto cemnertel <br /> Q Yes In No TTIIS IanK pfawauah nela Ilammaplp or mmclgdbW matEnals, If yea,me mea Irltd(ar amosphom aflall 4e m•IIcatea With a wMaaatble pas <br /> Indkatof p���tq went <br /> Tie IIV CIII Wucw on ma mnk- <br /> Cc riaari tan ma ta0Ament Inawmanm(or Scrap aamr.aklPaw relaray,CIC 1 <br /> A copy of ink camhrzq anal[acr-0mpany Stn lank to pre ttlaremgra(spasal hellly. <br /> RECEIVED FEB-]1-04 15:09 FROM-9168581011 TO-KLEEMAN ROEBBELEN PAGE 14 <br />