Laserfiche WebLink
FROM-:JIM THORPE OIL FAX &. :1 209 368 1851 Apr. 21 2006 09:37AM P1 <br /> TANK CLOSURE CE mmokTION FORM <br /> - a FAauxro• <br /> arse.oweas <br /> _ ,a <br /> CFS✓/ �pC <br /> eusrxEssarr / el�.a /•�. ,oa aUSInESaLv ? 7 ,oe <br /> TATA CAM[R <br /> TAMC ONEIEAA00NEN tin <br /> TAM(WMrae pTY �� 502 STATE Mo DP SM <br /> ����✓ CA, mss' G <br /> Tank A Flammable Vapor Oxygen <br /> (Stale Tank ID#.if applicable) Top Center Bottum TOP Center I Hamm <br /> Tank Interior �+ <br /> At=sphem <br /> Readings <br /> III GERTIFICADON <br /> On examination of the tank.Ice - u s visu product serdge.scale itNn.flaky residual of tank content),f(nseate and debris. I fuller certify <br /> that the information provided h t: acwra the bell of my knowledge. <br /> CERTIFIER SIGNATURE .1 TATuS OR AFFILIATION OF TIFYi PERSON ors <br /> CERTIFIER NAME as ' '-- Certifier N a reprosenfativa of the CIIPAILLk YES ❑ NO ❑ <br /> CERTIFIER TITLF <br /> Name of CUPAA,IA <br /> ADDRESS if mirdder is other Nan CUPA/LIA check wp-Priate box Delon. <br /> i <br /> CITY i ❑ Cadfled Industrial Hygienist(C" <br /> PHONE p <br /> DATE CERTIFIED sae CERTIFICATION TIME ❑ Carte Safety Professional(CSP) <br /> ❑ Cerdfled Marine Chemist(CMG) <br /> �f ❑ Regislered Envwonmemal Healdl Specialist(RENS) <br /> Professional Engineer(M <br /> t�/J7 ❑ Clasa II Registered Em4or nii Assessor <br /> / !_ r ❑ <br /> C,-,LB licensed cont aCbr(wdh hazardous sulntanm cern"c"te) <br /> 4-11 No This tank previousy held flarmma0Ill or combuabble olatenals. If yes.the tank interim almod epee sill C!rtldlec%ed wish a rnmbusdbb gas <br /> it d erdor prior to work being conblWA on Ble took <br /> Caniflefs tank management insulins far scrap deslirt,&W0111411blift SW Post-Ha Fax Note 7671 Q pagof <br /> es' <br /> Te / From <br /> Co. pt Co. ' r <br /> A copy of Nle edlificale shat)aeeErnp+ Fax# L 2 Fax it2-0 !G (lt <br />