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Tank a <br />(Stale Tank ICS. if applimble) <br />AalmnkdInotneerde' <br />sn,v.I] L uU <br />Readings <br />TANK CLOSURE CERTIEIC?.T t:N FORM <br />Flammable <br />On examination of ;tie tank. I cemty the cane Is visually Tree from P(Oduct. sludge. scale (thin, laky remdual of tank cantems), nnseate and aeons. I further certify <br />mat me information provided herein Is true and accurate to the nest of mY knowledge occcru ads <br />CIT. <br />W <br />r� <br />iae <br />L <br />ThIs tank prevbUely new flammable or mmoustible mal <br />Q Yes Q No indicator on" to work being conducted an Me tank. <br />Comfiers tank management instmmons tar smaP tlewer. disposal faelity, ac <br />Camfier .s a reoresematne of the CUPAIUA: YES Q NO Q <br />Name of CUPA/UA <br />If comfier is other than CUPA/LIA merx appmpnate box oelaw: <br />Q Camfied tridwatal Hygtentst PH) <br />Q Carolled Safety Prufesaianal (CSP) <br />Q Camfied Wane Caemtst (C -mc) <br />Q Regtslered Eltvvonmemal Health Specaiist (RE' S) <br />Q Prote ouanal Engineer (PE) <br />Q Crass II Registered Emitromnental Assessor <br />Q CSLB kensed emeacior (w M hazamaus substande demrtmte) <br />It yes• the tank Intend( abnaspnera Sri" be ro-rltedred wah a comousable 933 <br />Atopy at into Certlfimte shall acrxrttpany the tank ;a the <br />