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TANK CLOSURE CERTIFICA TION FORM <br /> J =3(711 1`7- fnf=N- 7 FIr nN <br /> BUSINESS NAMC 3 I PAC:UTY t0� t i <br /> The Stockton Record <br /> sr sccREss '� <br /> 530 E. Market St . <br /> 3USiNE53 CITY - 1(15 I aUSINg .p0 2 ca <br /> Stockton A ��f_ <br /> rANK C'NNER N?ME <br /> Stockton Newspapers, Inc. <br /> TANK'.;WNFA ACCRESS <br /> --I - P.O. Box 900 _ - --- - - - -- — <br /> vv+vSCZ Sr'A <br /> ,ARK NER CITY <br /> Stockton , CA i C Sa3 II? s6a <br /> CA 195201 <br /> 11 7ANKr nc I F I a <br /> Tank z Flammable Vapor Oxygen <br /> (State Tank!Cs,if applicable).- . Too Center Bottom Top Canter f Bottom <br /> Tank Interior I l <br /> Atmcsphere 01 <br /> Readings <br /> i <br /> On examination of the tank,I certify the tank is visually free`ram producL sludge.scale(thin,flaky residual of tank acntents),rinseate and decns. I Rather cenrfy <br /> that the information provided herein is true and accurate to the best of my kncwiedge. l <br /> C=RTiFiER SIGNATURE r� �tD STATUS OR AF=IL!ATICN CF CERTIFfiNG PERSON <br /> i <br /> CERTIFIER NAME(PRIN'n M"t In Thorpe Certifier is a representative of the CUPA/IIA: YES ❑ NO <br /> CERTIFIER TITLE 507 Contractor • <br /> Name of C'JPA/LA <br /> AGGRESS P.O.CX--95241-0357 <br /> BOX If certifier is other than CUPAAJA Ctecx appropriate box!selaw: <br /> ctrl Lodi , CA 9 - Q Cartified Industrial Hygienist(CIH) <br /> PHCNE(209 )368-6175 <br /> GA t cc CERTIFIED spa CERT1FiCAT10N T ME ❑ Cartr zed Safety Professional(CS?) <br /> n Q ❑ Carmfled Marine Chemist(C:dC) <br /> L(' <br /> 1 , 3L ! ❑ Registered F—mrironmental Health Specialist(RENS) <br /> Q Professional Engineer(PIE) <br /> C Cass it Registered E.-Mronmental Assessor <br /> 1 CSt.3 licensed comt3Cor(with hazardous substance certrfictte) <br /> Yes Q No This tank previously heli iammable or combustible materials. if yes.the tank interior atmosphere shad be re-Clacked Wim a comeusssnle gas <br /> indicator prior to work being conduced on lie tank. <br /> Certifiers tanK management inswuctions for soap dealer,disposal` aliity,atc <br /> None <br /> A ccoy of this certificate shall accomoany 118 tank:o the rec/Cing/duoesal aauty. <br />