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I ANK CL.CSU•RE CE?T)FICA—iICN FORM <br /> I =a r!j ITV <br /> � fr��Jr' -7741- <br /> Q <br /> 'E •CCRES3 / <br /> S„ess r <br /> VdJ w.��•L=aJ T �...,�•+-i 1j C' - '-0'l.�1.C.c�G.'�v (J t --.SiACf..I v�y( tfy I <br /> K + r=A AQCRESS <br /> P-C,O, N <br /> (�1\` <br /> —rte <br /> It TaNtC ri flct tR+=l r--,o.e4n(`�) <br /> I i anx Y �cr» <br /> raammaole'/aocr <br /> (State`ank IDS. .f 3c--tic3ble) <br /> j Tao Canter �Cr.C.':t ,c0 j Canter � 3ottcm <br /> --K Interior <br /> ,cs rere3� 7,1 <br /> I 7 77 7- 7 <br /> ixaminaron of the tank, lar•.fy'he;anx s•.isuatty free^m prccuC.;lodge.scale(thin, taxy residual of:anx wntents),nnseate srd de--ns. I fttrther,-zrrfy <br /> 'he mformadcn--rov,ded herein is true and 2c--;mte to the best of.-.Ty knowiedge. <br /> '7!FiF-R SIGNATURE 37.:,US OR aF=:(,:A,.CN OF Com=,lF'rtNG pc�SCu , <br /> '.TIRE?.NAME(PGIN� � - <br /> sas I <br /> Cartier is a recresert tuve of;he�'PA/L!A: YES ❑ v0 r <br /> .:,R ER TM iCJT <br /> 7' r' tName of CUPA/L-!A <br /> If eerufier 3 outer Man CU'PAA-IA=et*a=rocnate box oek w: <br /> NE g ❑ Cartrfied tndusc% t Hygienist(C: <br /> C=RT1F'E� sgca Cc--F T;F.;,t ATlCN-,IME C3Carified Safety Pnn* cna!(CS?) <br /> /•��Z�/ J7A4"- /`J iD(� ❑ Castled Marine Ctemat(C-SCI <br /> C] Registered Ervtronmemal HeaM Soe=list(Re-SI <br /> ❑ P ofessianal ^gineer(PE <br /> ❑ =a=Il Registered`crvirarxnentat Assessor <br /> CSL B fK~nsed Gmtaeor(,.,tit na=ardous substance cmfiate) <br /> is ❑ No -his'anx crevicusivneia "ammaote or cmousebte matenats. It yes, he tanx interior atrnaspnerr shalt be re-cued wttti a G7ritbtiSoDle gas <br /> e <br /> indlc3tcr--nor to werx being•onducted on the tank <br /> -etS;attK management ins r•GCns--r s=o dealer.disbaSa),aC;ity ate <br /> 1 i=cy-f:his=mficce snail ac--.zmcany me tanx:o me rec/c ngrdisoosat ac:ity. <br />