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TANK CLOSURE CERTIFICATICN ECRM <br /> I carll 17` IrFN_t E1CATION <br /> 3USIMEu r,Aue a Gury a <br /> Evelyn Pewitt Property <br /> sTc ACCNEu <br /> 2944 S. Airport Wray �s <br /> ausaEss arw icyuaGUb%p <br /> Stockton, CA S � <br /> TAMN Cvmf�i WMH aCa <br /> Evelyn Pewitt <br /> 6035 Condon Ave-., <br /> rANk CwME4ary SM STATE 5aa LV SM <br /> Los An 1Ps I C'A wMSR <br /> 11 a r c 'Ric n <br /> Tanks Flammaole,/acor oxygen I <br /> (State Tanx ICS, if acclicaole) Tap Canter sartom Top I Center I Sartom <br /> II <br /> Tank Interior 0 <br /> Atmosphere 3 <br /> ReadingsIII <br /> I I O <br /> On examination of the tank. I winty the tank is visually free tram product,sludge'sale(thin,flaky residual of tank contents),rinsaate and aeons. I further certify <br /> that the information provided herein is true and accurate to the nest at my'xnawledge. <br /> I 'ATUS OR AFFILIA71CN OF CERTI <br /> CERTIFIER SIGNATURE � FYING FERSCN �T <br /> CERTIFIER NAME(PRINT) sea Martin Thorp Carufier is a representative of the CUPA/L'A: YES Q NO ❑ <br /> CERTIFIER TITLE son <br /> Contractor Name of CUPM1lLIA <br /> AOCRESS ox If certifier is other than CUPAAjA check appropriate bas below: <br /> CITY Lodi CA 9 — ❑ Camfied Industrial Hygienist(C:H) <br /> PHCNE (2 — i <br /> DATE CERTIFIED sm CERTIFiCAT1ON TIME C2 Canifled Safely Professional <br /> IS _ D 3 Q Certified Marine Chemist(CMC)3 <br /> 3,G 1 , 415 ❑ Registered F_nvirdnmenal Health Spedalist(RE-+S) I <br /> Q Professional Engineer(PE) <br /> ❑ C:ass II Registered Environmental Assessor <br /> C, CSLS Iiuznsed ctin"Cor(with hazarcow substan2 wrtiflate) <br /> Yes ❑ Na This tank previously held lammaple or combustible matenals. If yes,the tank interior atmoschere shall he re-Cte k ci wbM a amewable gas <br /> indicator prior to work being conducted on the tank. <br /> Carifiers tank management instruaom for soap dealer,disposal faciliiry,atc <br /> A Copy of this uxmfiate shall a=mcany Te tank.o the nicictingidiscasal facility. �� <br />