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0 <br /> TANK CLCSURE CcRTIFiCA1CN FORM <br /> �v 1 N 1/ <br /> I csr,; I� Ir F.1Ti p:ncT C+n) I <br /> I 3LSiNEae NAMC ] I .AC.Ltt:O� + <br /> Lodi Air Port Maintenance Corp. <br /> .939 S —7 oL) //rc)y i9 <br /> ID <br /> aL$rNEau..tt s 3LSINESS-9 <br /> Acam o CA 95220 ! <br /> TANK c wea.WMR <br /> CY <br /> .ANK..naER ACCRESS Sal <br /> TANK..w E. C:TY <br /> nea- o a= I „A.E 903 1g�S�e i <br /> 11 Ta. r+ nc; 'FaNFnr%WmrN <br /> Tank: Rammacle Vaccr Oxygen <br /> ! (State Tank ICs,if 3onicaole) Too Carter 3oacm Too ! Carter ?crcm <br /> Tank interior <br /> Atmoscnere <br /> Reaaings <br /> ! I <br /> III <br /> I <br /> r V— I -1n I <br /> On examinaoort of:he tank. I cemtarm free ham product, slucge.scale(t6+n•laky resicual cf!anx amenrsr: <br /> s),nnseate ana cec . I further tev <br /> that the nfonnaven prov, n ein. tm5o r. c to to Ne cess of my knowledge. <br /> i <br /> I CERTIFIER SIGNATURE —A—US CP.AFz ,47CN CF C .R TIF!ING=ERSCN scs <br /> CERTIFIER NAME(PRINT) su Canfier is a representative of the CUPAiLIA: YES Q NO <br /> CERTIFIER TITLE em <br /> Contractor Name ofCUFA/L!A <br /> ACCR='S P.O. Box 357 <br /> I C1 i! - If cer..fier s ether than CUPAiL;A CeCc apcmonare cox ce!cw: <br /> Lodi , CA 95241-0357 I C Camfiec Inca tral Hygienist(CH) <br /> I PHCNE (209)368-6175 <br /> ! <br /> DATE CERTIFIED sae CcRTiFCATICN TIME C Carttfieo Safety Professional(CSF) <br /> �j 7,�� ❑ Caruffed Manne Cnema t(C.mc) <br /> a <br /> `/9 O `� P/ �- C .Registered Erviranmenal Health Soeaalist(4E=S) <br /> Professrcnai E.ngmeer(PE; <br /> Cass II Registered Environmental Assessor <br /> CSL9 11censed=raracar(with haZ3raeus SUdstanC armficstei <br /> Q yes C2 No 'his tank prewausly held lamma le or ccmousti matenals. If yes. to anK interor acnoscnem shall De rsti:.ecKr]with a cmcuscdle gas <br /> ind©tcr prior+a worn teing ccaucted an the mnx. <br /> Canners talIK management i:stucuers for soap eeaier.disposal mip!ity,etc: <br /> ii <br /> i <br /> I <br /> I <br /> A acy of:ria xrtificare snail accompany me mrix:a me rec/mrig/cisweai faciity. <br />