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TANK CLOSURE CERTIFICATION FORM <br /> G IDENTIFICATION <br /> I FA <br /> BVNwE55 WYE aUT 100 + <br /> Levand-Bright Family Trust <br /> +o. <br /> 5'E �DpRE:S <br /> 3 East Eleventh Street <br /> ausiwEu c^. Tracy CA +os aus+wEss ae 95376 ,oe <br /> 'AMM Cv+wEA w.YE <br /> Louis Levand Trust <br /> r.wR c++wEa�oDREu <br /> so, <br /> Louis Levand Trust c/o Paula Levand <br /> 24692 Sand Wedge Lane, <br /> -I.wR Q+IwER C:tt � Sat ST�:E s:a i.R SG <br /> Valencia CA I 91355 <br /> I SII <br /> Tank a Flammable vapor Okygen <br /> (Slate Tank IDa•d applicaNe) TOP Genter 9oRom Top Cemer Bottom <br /> Tank interior 39-0520751 10.0 —Y + 0.0 I 20 I 20 I 20 <br /> Atmosphere <br /> Readings <br /> QQOF���pM R <br /> No. 7473 <br /> On examination of:he tank.I c mfy the tank is visually`"from product sludge <br /> that:he information provided herein is ave and accvnte:o the best of my knowlt <br /> CERTIFIER SIGNATURE <br /> CERTIFIER NAME(PRINT) nos Ilam Little <br /> CERTIFIER TITLE acr Professional Geologist F� OF CA1.�F0 <br /> ADDRESS 837 Shaw Road <br /> Crry Stockton, CA, 95215 <br /> U Cervfied Industrial Hygienist(CtH) <br /> PHONE 800-511-9300 C1 Cen�ed Safety Profeuional(CSP) <br /> DATE CERTIFIED sae CERTIFIG;TION TIME <br /> ❑ Cerili Manne Chemist(CMC) <br /> 05/01/2014 12:30 pm ❑ Registered Environmental Health Specalst(RE:�S) <br /> ❑ Professional Engineer(PE) <br /> ❑ C:3¢ II Registered Environmental Assessor <br /> El CSLB ricensed mmnaor(with hazardous substance Mnlf=tef <br /> ❑ yes L'.] Nd This tank previously held lfammaDle or mmbusnble materials. it yes.the tank interior atmosphere shall be re-c:)edmd with a combustible gas <br /> indimlor prior to wont being mno=c on the tank- <br /> Canfers tank management Inst c6ons for soap deaW.disposal facley,etc i <br /> Tank Recycled for Scrap Metal. <br /> A copy of this CemfiUte shall aimompany the tank to the repyCing/disposal faality. <br />