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MODEL <br /> Tank and Secondary Containment <br /> Assessment Document <br /> This document was prepared for: <br /> Company Name: TIGER LINES <br /> Address: 927 Black Diamond Way <br /> City, California ZIP: Lodi, Ca 95241-1120 <br /> Tank/system identification: USED OIL <br /> Date of Inspection(s)/Assessment: <br /> 6/20/2016 <br /> This report consists of 21 pages <br /> I certify under penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that qualified personnel <br /> properly gather and evaluate the information submitted. Based on my inquiry of the person or <br /> persons who manage the system, or those persons directly responsible for gathering the <br /> information,the information submitted is,to be the best of my knowledge and belief,true, <br /> accurate, and complete. I am aware that there are significant penalties for submitting false <br /> information, including the possibility of fine and imprisonment for knowing violations. <br /> Engineer's Name: Mike Smith Engineering, Inc. ,.�?;—Q HE S <br /> License Number: 44590VAI S �[ <br /> License Type: R.C.E. �' Q• <br /> Address of Engineer: 4. N. Main St./P.O. Box 611 , [� <br /> Lodi, Ca 95240 <br /> * - 04 .90 <br /> Inspector name (if supervised by P <br /> assessor above) LP Michael W. Smithq� C/V I <br /> C Al 1F�1 <br /> Date Stamped/Signed <br /> Tiger Lines Used Motor Oil <br />