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TIGHTNESS TEST CERTIFICATION <br /> I, the undersigned, hereby swear and attest that I have performed a precision test in accordance <br /> with NLPA Standard 631, Chapter A, Section 13.1.3 and A14.2.1 or A14.2.2 on the above <br /> designated tank and certify that the tank was "tight" and in compliance with 40 CFR 280.33(d)(1) <br /> and that the tank passed the precision tightness test in accordance with NLPA Standard 631, <br /> Chapter A: <br /> Signed Date SPECIAL INSPECTORS OR <br /> QUALIFIED PERSONS SIGNATURE <br /> I have not performed a precision test in accordance with Chapter A of NLPA 631: <br /> Signed Date <br /> SPECIAL INSPECTORS OR <br /> QUALIFIED PERSONS SIGNATURE <br /> MATERIAL AND PERFORMANCE CERTIFICATION <br /> I,the undersigned,hereby swear and attest that the following specified materials and quantities of <br /> materials were used in performing the work on the above designated tank. <br /> GALLONS OF LINING MATERIAL USED: Gallons <br /> MANUFACTURER AND NAME COMPLETE ADDRESS OF LINING <br /> OF LINING MATERIAL MATERIAL MANUFACTURER <br /> Lining Material Batch Number <br /> ESTIMATED POUNDS OF SAND USED FOR Abrasive BLASTING <br /> Pounds <br /> TYPE AND GRIT SIZE <br /> Signed Date <br /> SPECIAL INSPECTOR OR <br /> QUALIFIED PERSON SIGNATURE <br /> Page 2 of 3 <br /> 14 <br />