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Tank and �eGandary Carttairtr��rtt <br />As�as6rrtan# l�dcum�nt <br />This docutr�ent was prepared for; <br />Midas Tracy <br />2615 West rarant Line Road <br />Tracy, CA 8576 <br />Tank/system identification: <br />Used Mt�tc�r C3il storage SIN 4t3C►$d80A <br />Date of inspection{s)/assessment; <br />March 1$, 2p1 � <br />This re Ort consl$ts of 11 a es. <br />1 cerilfy under penalty of taw 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 ga#her and evaluate the information submitted. based on my inquiry of the person or <br />persons who manage the system, ar #hose persons directly responsible for gathering the information, <br />he information submitted Is, to be the best of my knowledge and belief, true, accurate, and <br />complete. I am aware that there are significant penalties for submitting false information, including <br />he flssibilit of fine and Im rlsonment far knowin violations. <br />engineer's name: Jeffrey i<. Belwoad, Robert F. Martin <br />License Number: M�297t75, C-53437 <br />License Type: Mechanfcai, Civil <br />ddress of engineer: PO gax 93134, �tacktan, t1A 952U8�rr. Ripon CA <br />95366 �""`^�,.��..,, <br />FESSr � �� t.,�y„� <br />'+" �y,�► t� �' Exp. �+1�►��/'i ; <br />'��` iaF cii+���o� <br />. Date stampedlsigned; April 1, 2Q19 <br />r <br />7�I n <br />aaa � gv� za:aa $�aaiaai�a <br />