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I ANK CLOSURE CERTIFICATION FORM <br />P.w d <br />=Ar.11 r7Y <br />1QFN71CIrArQN <br />aUSI•ME55 euYE <br />3 ACUTY Ia• 1 <br />I' <br />Redevelopment'AgencV of Stockton <br />SME A00116 s <br />IM <br />Block bounded by Lafayette, El Dorado, Center and Sonora Streets <br />aueelEss-Y <br />Stockton <br />f03 <br />auS1,11M DP 95202 tin <br />'AW CAMErI NAME <br />RedgypIngment Agency of Stockton <br />Sm <br />TN OM!Vt AoaaEEa <br />301 <br />305 N. El Dorado Street, Suite <br />- A,M cAvlee ar <br />sdx <br />srA:E ol Y soA <br />S <br />Stockton <br />CA 195202 <br />II TANK r1 ^SI <br />(RF !NE)EMATICTN <br />! Tank a <br />Plammadle vapor <br />Oxygen <br />Canter <br />I 30ttom <br />(Stale Taint I(a. H lio <br />appdte) I Tdo <br />Center 3ddom Top <br />I <br />'anK ntenor <br />Atmcsonere <br />i <br />1 1,500 gal. tank 1 <br />- 1 <br />19.4 <br />19.5 <br />19.5 <br />Readings <br />On examination of the tank, f certify the tank is visualry free from product. sludge. sale (thin. 'laky residual of tank contents), rmseate and aeons. I ftlydfer certify <br />that me information provided hereof is true and a=rate to me oast of my knowledge. <br />CERTIFIER SIGNATURE - <br />STATUS OR AFFILIATION OF CERTIFYING PERSON 3n <br />I Carftfier is a representative of the CUPAAJA: YES ❑ NO ❑ <br />j <br />CER^FIER NAME (PRI scs o n Cr--aVit&rd <br />CERTIMERTITLE sin Pro set Manager <br />Evans Brothers Inc. <br />Name of CUPAA.A <br />K cantfier S odler malt CUPAIWI Cfecif: ]pprol#fate Ydz Below: <br />I ❑ Certified Ind=nx1 Hygienist (Chi) <br />I ❑ Cardfied safety Professianal (CSP) <br />AOORESS 7589. National Drive <br />CITY Livermore, CA 94550 <br />PHONE 925-443-0225 <br />DATE CERTIFIED sir CERTIFICATION TIME <br />❑ Camfieo Manne Chemist (C%iq <br />20 Sep 99 1400 Hrs. <br />❑ Registered F -m onmenul Heath Specafist (RE: iS) <br />P9❑ ❑ iomfessional Engineer (P9- <br />r7Gass 11 Registered Emvonmenral Assessor <br />• <br />KI :SLB licensed contractor (calm n=aroous sudsanra cernfloate) <br />Yes ❑ No This tWK preyieu ty held iammaele or aomo=ble matenals. f yes.:he !arlK imenor almosphere sine be niC Med with a comoUSdhle gas <br />indicator prior to work zing conducted an me tank. <br />li CaniheYs tank management insduimons for 3=93 dealer. disposal facility. atC <br />Tank has a low LEL reading and fuel smell. <br />Tank has no residuals, so it is to be in <br />j inerted with dry ice and hauled to Ecoloty Control Industries yard where it will be <br />decontaminated, cut up and scraped at metal <br />recycler. <br />- - to <br />I Appy at this ®mfiwte shad aeedmparty 20 tY1K to 1219 reryeingldisoosal `dairy. -� <br />