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10/17/2000' 09:00 2094683413 FIFTH FLOOR PAGE 12 <br /> TANK CLOSURE CERTwirAmN FoRm <br /> eLe;A+F,^K roue s ..auavw. r <br /> PACIFIC AVENUE ARCO STATION <br /> ei;i Aaoaes3 <br /> 1M <br /> 6425 PACIFIC AVENUE <br /> BU5INESSCtTY .ps dVSWE3S ZIP —� <br /> eTnrKrnnl SA <br /> .W K v.�eF!ropw <br /> MASON CENTER [ L(-./ MARK YFKTA <br /> r xpYa+CRw MESS for <br /> P . O. BOX 2228 <br /> TA KOWkE0. Sat STATE 5aa ` no Sat <br /> ANVILLE, CA f} <br /> 94526 <br /> Tanks Flammable Nacar Oxygen <br /> (State Tann/OS.'A ap*coble) Top Center Sown, lap Centex aoddm <br /> Tank lntenor <br /> Atn+dsphem <br /> Readings M <br /> 1 <br /> 111 CERTIFICATrON <br /> On examination of the tank,l candy the tank is viswRy heft kbm pfd=sludge,scale Ithin,flaky residual of tanK contents),nneests and detfds. i Wether amfy <br /> that Ina inf0/lna110n pr0vaied herein i9 frrfe and acewate to ate best of my knewiedge. <br /> CF—RTIFIER Stil NATURP STATUS OR AFF0.tATION of CER71FY1NG PERSON sn <br /> CERTIFIER NAME(PRIM") soft Certifier is a reprssenralive of me CUPAn IA YES Q NO <br /> CERTIFIER TITLE sm <br /> Noma of CUPAnIA <br /> A00RESs <br /> CITY if cernlier is other than CUFKLLA rne=apprapnate tics below: <br /> PHONE D Cardfied Ilalustriat Hygienist(CIH) <br /> LATE CERTIFIED sea CERTIFICATION TIME 0 Omitted Safety f4olemicnal(CSP) <br /> Q Caro"mar"Chemist pmim <br /> ❑ ReyiNered ERNranmantal Health 3pamakt(RENS) <br /> Q PIOlpyafpnaf E}rgir aer(PE) <br /> Q Cress 11 Registered EmAremnantat ASMSa r <br /> Q CSL9 Rcensed eoneacta(wim hakemaus suastam a certKeate) <br /> ❑Yes C1 Ne This tank Previnunty nand aarraslahfe or cdmGtsWe matenms. it yes.We ta*aKeitdr abadsphera shah be re4tatdted with a wrr+busd6le gas <br /> Indicator pride to wax being conducted an are rank_ <br /> CaNfuara ewJv manag...+eW.fes:M..tue s to,x daeter,dlapaeal&Maty.etc <br /> A Caay of this aardfieata arise ateoreparry the tank to the mdyCingfdutpeaal taaay. <br />