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ARIA <br />TANK CLOSURE CERTIFICATION FORM <br />�—I F <br />BusiNEss N.yq A� a F.GUrr ro • 1 <br />,W <br />SrM ADDRESS <br />WSINESS Cn <br />'ANI( CwNER NAPE <br />:ANN C.YNER ADDRESS <br />TANK JWM�/TYI SD2 STA iV/ / <br />7 <br />Tank! <br />(Stale Tank IDS. it applicable) <br />Tank Interior <br />Atmosphere <br />Readings <br />Flammable Vapor <br />TDo Center Bottom <br />.3a <br />Center <br />3M <br /><I. 0 <br />On examination of the tank. I certify the tank is visually free from produG sludge. scale (thin. flaky residual of tank contents). rinseale and aeons. I further certify <br />that the information provided herein is we and a=mle to the best of my knowledge. <br />a] <br />CERTIFIER NAME (PRINT) XA Vow �• — Camfier is a representative of ;he CUPArLIA YES C]NOt.+ <br />CERTIFIER TITLE W7 15v/0!4I <br />Name of CUPA/LLA <br />ADDRESS w Uf If certifier B other than CUPAILIA check appropriate box below: <br />CITY <br />PHONE .� ❑ Cerdfied Industrial Hygienist (CIH) <br />DATE CERTIFIED Su CERTIF GTION T1M C3 Cerfied Safety Professional (CSP) <br />❑ Certified Marine Chemist (CMC) <br />3 P let/ ❑ Registered Environmental Health Specalist (RENS) <br />1���0 �� ❑ Professional Engineer (PE) <br />❑ C:ass II Registered Environmenml Assessor <br />i5l"CSLB licensed conlra=f (with hazardous substance certificate) <br />pj,Yes ❑ No This lank previously held flammable or comou tlble materials. It yes. the Lank interior atmosphere shaa be re-elected with a combustible gas <br />indicator prior to work being conduced on the tank. <br />Canlfiefs lank management in cdons for soap dealer, disposal facility. etc ' <br />A copy of this Certificate shall accompany the tank to Ire rect a ngra,sposal raomy. I <br />