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TANK CLOSURE CERTIFiCATiON FORM <br /> +sqr d <br /> t <br /> BUS+wESS lcAraE 3 iACSUTY 1G• � <br /> Levand-Bright Family Trust <br /> SrTz ADDRESS 'w <br /> 3 East Eleventh Street <br /> eus+NEss cn*f Tracy CA +cs ay.10N M``i' 95376 <br /> TANX C WER"ME coo <br /> Louis Levand Trust <br /> -A►rx C+MEI;ApiNtE55 <br /> Louis Levand Trust c/o Paula Levand <br /> 24692 Sand Wedge Lane, <br /> ',ANK OVOWOi CtTv Stat siA:E SCS :.P SM <br /> Valencia CA 91355 <br /> it TANKc <br /> Tank Ftammable vapor oxygen <br /> (State Tank 10*.if applicabre) Too Center 3onom Top Center Bottom <br /> Tank Interior 39-0520751 0.0 0.0 0.0 I 20 20 ( 20 <br /> Atmosphere i <br /> Reaaings <br /> boNAL G <br /> Na. 7473 <br /> On examination of the Sank,1 cenity the tank is visuatty tee from produc,sfwge <br /> that the information prowaed herein is true and accurate to the best of my knCwi+ <br /> CERTIFIER SIGNATURE <br /> CERTIFIER NAME(PRINT) saa William Little <br /> CERTIFIER TITLE sw Professional Geologist —OFOA�1� <br /> ADDRESS 837 Shaw Roaa <br /> CIT`! Stockton, CA, 95215 <br /> L.J Certifies!Indusitial Hygienist(CIH) <br /> PHONE800-511-9300 <br /> S3ATE CERTIFIED sox CERTIFICATION TIME ❑ Certified Safety Professional(CSP) <br /> ❑ Carufled Mann Chemast(CMC) <br /> 05/01/2014 12:30 pm ❑ Registered Environmental Health Speciaf+st(RE-+S) <br /> ❑ Professional Engineer(PE) <br /> Cass t1 Registered Ertvironmentat Assessor <br /> E) CSL&Fcensed contraccor(with hazardous substance centlicate) <br /> ❑ yes 6 NO This tank previously head Aammaole or combusa'ble matenats. tf yes.the tank interior atmosphere shag be re-dweoited wrttt a combustible gas <br /> indicator prior to work being conducted on the tank. <br /> Cartifiers tank management instwctions for scrap dealer,disposal famlify,eic: <br /> Tank Recycled for Scrap Metal. <br /> A copy of this certificate shag accompany the tank to the recyi--ingidisposal facility. <br />