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TANK CLOSURE CcRTiFICATICN FORM <br /> �•�• 1 1 <br /> ausiNEss <br /> Services s I AAGL-N o. f <br /> ,a <br /> 3r +cca�=s <br /> 3505 Navy Dr. <br /> .::T'r t05 II aus7NESS�P 106 <br /> aUsiNESS <br /> Stock nn , CA fg��na <br /> rANK.^..vNET,w.ME SOC <br /> ST Services I <br /> 60 1 <br /> rANK�'NNEa ACCRESS <br /> -2941 Navy Dr. - --- -- - — --- <br /> ;.WKCNNERC:rf SOZ A. sae IIP A+ <br /> Stockton, CA ` 95206-1149 <br /> t A c' IPP I <br /> Tanks F?ammaole vacor oxygen <br /> (State Tank ICs.-if appticacle) Too Center 9ottom Top Canter Bottom <br /> i <br /> Tank Interior <br /> Atmosphere <br /> Readings i <br /> I <br /> I I I <br /> On examination of the tank. I Certify the tank is visually free from oreducL sludge.scale(thin.AaKy residual of tank contents),rinseate and aeons. I further certify I <br /> that the information provided herein is true and accurate to the best of my knowiedge. <br /> CERTIFIER SIGNATURE STA US OR AFFILWICN OF CERT1F!1NG PERSON jcs <br /> CERTIFIER NAME(PRINT) certifier is a representative of the CtjpMjA: YES Q NOM <br /> CERTIFIER TITLE sal <br /> Contractor Name of CUPAlUA <br /> ACCRESS P.O. BOX 357 If certifer;s other Mart C:iPAiLA Ctecdt appropriate box belay+: <br /> CITY Lodi CA ❑ Certified Industhal Hygienist(CH) <br /> PHONE (209)368-6175 ❑ Certified Safety Professional(CSP) <br /> CA—L=cc CERTIFIED sm C RTIFIC.tiTICN TIME <br /> 7I � D � <br /> ©, �� Q Certified Marine Chemist(C:dC) <br /> / ❑ Registered Emrironmentat Health Soecatist(RE: <br /> f ❑ Professional Engineer(P9 <br /> Q C:ass it Registered Environmental Assessor <br /> I$j CSLS licensed contractor(w,th hazardcus substance Ceraflcste) <br /> C§Yas Q No This tank previously hefd lammaete or comousuble materials. If yes.the tank interior almos°here sitall be re-CieGced with a CpTOusIIble gas <br /> indicator prior to work teeing conducted on the tank. <br /> Canifiers tank management instructions for sGaa dealer.disposal facility.etc <br /> None <br /> t <br /> I <br /> A cpy of this certificate snail accompany the tank.o the reeyC.ngldisoosal faciity. <br />