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' TANK CERTIFICATION <br /> ' *••'+'•`•'•a••••• PA,IRT!- To be wmpleted by di. Custcmer ",•`••••••••••""•• <br /> fLUSTOMER: 1��� Z TJv �` S GENERATOR: <br /> OCATION• 7F4)Qg T 'c o S�f\rl) ��G�(bt EPA I.D. 9: Zl Ou <br /> TRANSPORTER: I.L MANIFEST 0: <br /> TANX t TANK 2 TAMC 3 TANK 4 TANK 5 TANK 6 <br /> TANK #.- 3_�`t <br /> 1 <br /> CAPACITY: <br /> DIAMETER: �� <br /> LENGTH: Z6 <br /> ' STEM I GLASS: S <br /> ' LAST CONTAINED: LCA <br /> LG = 1 Gas, UG - Unleaded Gas, D — Dlesel, UO - Used Oil, FO — Fuel Oa <br /> Specify TA maga! Last Contained rf o&w than tt-4 shave. <br /> ' I hereby decfare that the tanklsl luted above on thss Tank Certirtcatron form are fully and accurately described, <br /> grid the tanks on the transport egrdpment have been nwnbeucd to correspond with the mformman provided <br /> above. In the event that the maks do not t2lrrLspond to the form, or contsln excessive solids or Agtdds, I w� <br /> kwany and elf costs incsArred in ree0yer g the dlscrepancyfresl between the tankfs/ and the foray or for <br /> evwAnZ arranpog for and transpormg far [GsposW or racycfinp of the excessive meterxd according to dw <br /> schedule of chwgits ect of t&m afl#4,ipt of the tanklsl. - <br /> CUSTOMER SIGNATURE DATE- <br /> For as= in ckmi l"ng vis fan". pies"ca uct Xmww .t M1402967251 <br /> ' s••s* w w. PART H- To be completed by ERICKSON Tank Processing r••r a.a a r.• <br /> TANK I TANK 2 TANK 3 TANK 4 TANK 5 TANK 5 <br /> RECEIVED- <br /> CLEANED <br /> G.F. CERTIFIED. <br /> WASTE SOLIDS: <br /> ' WASTE RINSATE. <br /> USED OIL <br /> ' ERICKSON SUPERVISOR SIGNATURE: DATE; <br /> TIFICATION FORM IS OK_ NOT OK SEE REVISED COPY: <br /> OFF LOADED BY: DATE: <br /> ' State Transporters I D: osearsa,.t <br /> 200 39ud DNI NOSXDId3 W08GE '01 16 , E D3O <br />