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TANK CLOSURE CERTIFICATION FORM <br /> 3uSiNE55 NnwE a :Kluw <br /> A. Teichert & Son, Inc. 4027 <br /> v c +OoaE55 tU <br /> 103 North E Street <br /> iUsiNEiS CITY ipa aUstNE5521v tCd <br /> Stockton 95205 <br /> ->MK cku�FR Nw.kE Soo <br /> A. Teichert & Son Inc. <br /> P. O. Box 15002 <br /> ->NK JY Ert CITY 5@ S1A� Saa dv 50+ <br /> Sacramento CA 95851 <br /> Tank s Flammacle vapor Oxygen <br /> (State Tank ICt.if appti sole) Top Center Bottom Top Canter Bottom <br /> 7anK Interiorll � <br /> ;tmasphere 1555-05 d7 6//` Q �O 77 ��O 7 /U <br /> Readings /' <br /> 1555-06 0/OI d / D7, I 7�6 7% �a/6 <br /> III r5=_;RTjFIrATl0N <br /> Jn emminatlon of the tank.I ceruy the tank is vispally Gee from produri sludge.scale(thus.Itaky residual of tank comems),ruueate and aeons. I further Lenity <br /> :hat the information provided herein is true and this hest of my knowleilge. <br /> CERTIFIER SIGNATURE STATUS OR AFFILIATION OF CERTIFYING PERSON nos ' <br /> CERTIFIER NAME(PRINT) 50iilJer Sherman Canifer is a representative of fie CUPAUA: YES ❑ NO Q <br /> ]E.RTIFiER TITLE sm <br /> Boiler Maker Name of CUPAnJA <br /> ADCRESS 3525 5 2nd Ave. H cordfler is other than CUPAAJA check appropriate cox below: <br /> CITY Sacramento Q CernBed Industrial lygwust(OH) <br /> -HONE915-421-1990 <br /> DATE CERTIFIED she CERTIFICATION TIME C3 Cerdfied fey Pr°fesswnal(CSP) <br /> 12-21-98 1 : 15 pm Cl Cerdfled Mame Chemist(CMC) <br /> Cl Registered Emrironmer"Health Specialist(RFriS) <br /> ❑ Professional Engineer(PE) <br /> ❑ Cass II Registered Envirommemal Assessor <br /> ❑ CSLB licensed cortdactor(with hazardous sututarnca cerdflrate) <br /> ® Yes Cl No This tank prewausly held flammable or mmbusoble mamnals. If yea.the tank interior abnosphae shall be se-cocked with a wrilbus7lele 935 <br /> indicator prior to work being conduced on the tare- <br /> ':aniflers tank management insfrUGtlons for Soap dealer,disposal faaw.eta <br /> A Copy of It=certificate snall accompany the tank to the recvaing/disoosal facility. <br />