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Jun•30. 1999 8:51AM CL BRY,ANT No -0584 P 3/5 <br />TANK CLosvnn CFJMFiCAT10N FORM <br />OSI lRFArAEPBMAljQN <br />Tank 4 H m,iumo Vapor Oxygen <br />are WIM S RtCItJTYIOr t <br />Cenfer aduan Tap Carter Bolcom <br />UM d AP 104 <br />wwss csrr <br />T' <br />TANK G4}MiE+FtyAOOR & �(L ,y/,� <br />TI, 6UVtIP3t Cf rY 502 <br />�TA7'[ S03 � F3M1 <br />OSI lRFArAEPBMAljQN <br />Tank 4 H m,iumo Vapor Oxygen <br />f State Tanis IDs. if Poo cabie) Top <br />Cenfer aduan Tap Carter Bolcom <br />Tank It dor <br />Atmocpttero <br />i <br />t <br />.t <br />f <br />an exammaion of wA tanK. I certify the tank is viauatly fres from prroducr, sludge, 3raia (lain, flaky rest k" of tank WnWMS), risaaa,e anis dasx,s. s to—Ml am" <br />Mai the informakm provided herein is Ma acid accw w to Me best of my knawleNs. <br />f:! RTtFER StGNATUR)= <br />STATUS 4R AfTRUATION OF CERTIFYING P RS(>rl 306 <br />CER" lRER NAME (FRI[^If) <br />CAmt im is a Tapreset> ove of the G7WMLtA YES 0 NO Q <br />CFr7IRF-R ?iTL!Z W7 <br />Natrrs of GiJF'AlCTA <br />At�FeESS <br />If certifier iv other than CiJP41- A ctmck appropriate ppx deiow: <br />CITY <br />[� C&tw In kaml Hygienist (c" <br />PtiONE <br />Q '� 5aE9ty ,xraiee�sar►af tom') <br />DATE CERTiF1Ep sus C@fIT1FlCATiON TIME <br />Q CdMed Markw Chen -d Phllq <br />Q Rog,$Wlod 5,Mrana*ntal NeaMh SpeaaW (POTS) <br />Q PTotosslanai Emp-wer (1'f -z) <br />Q Cross Il P.Agistamd E-nviraomwaW A5,w� <br />Q CSLS hmnsed Wntraclar lv-m narareaus sdmawca Ow#*;Ote) <br />Yes Q No This tank previously tvaid tt ammatsie or comhusidsle rnatefials. <br />It yes, ttsa tank lrMrtor aftnaspttare dtsail be re--dveckad wish a wrr gas <br />indb=kor pix to work ENng oonducled an tm Wk- <br />C,esStlers tante managomeil kmmadons for scrap dealar, dirpmW fads , eta <br />A copy of tela cMffcate shall a =repaM tae tank to tlw rotydingfdisposal laphty, <br />