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Crv-Rp Constructi -..,Co. <br /> Phone 734-6381 Contractors License <br /> Post Office Box 1066 478335 <br /> VISRLiR,CALIFORNIA 93279 Class RC61 <br /> Emergency Phone:(209) 732-0602 Ins.PL 6 PD <br /> A Fuel Station, Maintenance 81 Service Company <br /> TRIPLE RINSE CERTIFICATION <br /> t .I hereby certify that I have triple rinsed.the described fueltank below to county and state specifications. <br /> Type of fuel <br /> Type of tank: Steel ❑ Glass Est. Size of Tank /O aQ(o AO�� <br /> Tank No. � ' X <br /> Address of tank <br /> City/State �� � EG'•Q �� X5336' <br /> Name of owner of tank <br /> Address of owner of tank Z00 Z �U z909It <br /> City/State/Zip � ?f�L ,.o �s--x'31 <br /> Transporter of Rinse f/��p�ES s�,ey/�E State No: l a 8 ;>7 <br />' Destination 3 3 3 S- : <br /> Signature <br /> R <br /> W ss <br /> f• <br /> Date ev-,oe_ Z zc, 9 <br /> 1 <br />