Laserfiche WebLink
AUG_31-2000 THU 10:05 C H W <br />ACRAMENTO <br />FAQ, NO. 01 -It 51033 F. 02 <br />TANK --L GSURE CciA."F:CA7ICN FORM <br />'N- -1 . l <br />IDEN11FICAEGNf <br />Iusll<ss MAMA fff """ <br />' ` <br />2 RACJUT` iC * i <br />,/� <br />SST! •C0a1055 <br />iW <br />as it s.veSS cp x <br />au-11ITf <br />-2-1 <br />r <br />rAMK 0WHER •MANS <br />A) aPfnj.i�(��{_i✓ <br />1 Sc:Q <br />r'AHi Z?"ER Aocaaess <br />W to j C_�Z.lin� <br />x" <br />I <br />int? <br />• Tr.HK O NN" Clrr - <br />SM VkTE $03 ` :P !c. <br />CA I C1 C`a Z() _ - J <br />Tank 0 <br />(State 'ank Ics, t appiirab+e) <br />Tank Interfax <br />Reaa! gs re L Sr' <br />/ <br />rt;miraolr* 'r3Qbr <br />Oxv4en <br />Center E7ttCm <br />Top Cemer SWOrt <br />CERTkFiER NAME (PRiN i 7 sea r.1 <br />Cartiner is a representative at the CUPAj'UA. YES ❑ NO Q <br />j CERTIFIER TITLE ser <br />-2-1 <br />r <br />_ <br />1 :erttlsr is cther Stain CLPAA.:A cMeck ap^,rcprlale bcx bekrw: <br />CITY f {�-rvl� S <br />L1 Cervffed Irtdwtnat > fygienfst (CiH} <br />PHChE <br />Q CarTAa-d S44ty Preesslcnal (C -SP) R <br />CAT' -= CiERTIFIED sae <br />CER-1FICA+TION TIME <br />'In examination of the tank. i ronify the tank is visually free from product_ sludge. Seaie (thin, flaky res dual of tanK scinlen,sl. rinseate and debns. I ivrther cattYi'y <br />that ;he infannation provided hates a and ato the est of my k awledge. <br />CERTIFIER SIGNATURr I STA"US OR AFFILWTiON OF "ERTtFYltjG P,RSCN las <br />CERTkFiER NAME (PRiN i 7 sea r.1 <br />Cartiner is a representative at the CUPAj'UA. YES ❑ NO Q <br />j CERTIFIER TITLE ser <br />Name of CUPA LA <br />—y <br />f A©DRESS / C) I <br />1 :erttlsr is cther Stain CLPAA.:A cMeck ap^,rcprlale bcx bekrw: <br />CITY f {�-rvl� S <br />L1 Cervffed Irtdwtnat > fygienfst (CiH} <br />PHChE <br />Q CarTAa-d S44ty Preesslcnal (C -SP) R <br />CAT' -= CiERTIFIED sae <br />CER-1FICA+TION TIME <br />C:Ctni!ied Marine Chemist (C.MC) <br />I <br />Q Registe� Fnwironmental Health Speaafls; ,REHS) <br />©� <br />❑ Pmfess;cnai Engineer (PE) I <br />Q (:lass it Registered ErMrommentat Asussor <br />I <br />CSL3 Jcaesad =rrraclor ('frith naz2raous sAslanca canrmcate) <br />Yee Q No T118 tanK previollaty held f!ammaale or cc,oust ble malltnaas. <br />If yes. rise rami imertor almasphem shall 5e , -satxed weft a tambustib:e gas I <br />I ind!.tcr pror:.o work being �awducetsd an the ank_ <br />CanlAafs tank managamant'nstruc*lo far srsap aaaaar, dispcaal faoiR/, am: <br />`b i 5 DSS a�_i le+- -1 �4 w i• -f`, czti-e , <br />I A. copy of this Car^ifldate shall .accompany the lark 10 ase rex VCingadIspcsal facility. <br />