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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Page of <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME Berne as FACILIW NAME or DBA-Doing Business As) 3 FACILITY ID# - 1 <br /> Arco Facility#0760 Ar <br /> TANK OWNER NAME 740 <br /> Arco Products Company <br /> TANK OWNER ADDRESS 741 <br /> 4 Centerpointe Drive <br /> TANK OWNER CITY La Palma 742 STATE CA 743 i ZIP CODE 906231066 744 <br /> 11. TANK CLOSURE INFORMATION <br /> Tank ID# Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach eddalo al <br /> copies of We page for p <br /> TANK To Center Bottom Top Center Bottom <br /> more clan three conks) <br /> INTERIORf 745 746a 746b 746c 747a 747b 747c <br /> ATMOSPHERE <br /> READINGS Z 748 749a 7491, 749c 7500 750b 750c <br /> 3 751 752a 752b 752c 753a 753E 753c <br /> 111. CERTI ATION <br /> On examination of the tank, I certify the tank is visually free from product,sludge,scale(thin,flaky residual of tank contents), rinseate and debris. I <br /> further certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Certifier is a representative of the CUPA,authorized agency,or LA. 760 <br /> NAME OF CERTIFIER (pma) 754 ❑ Yes ❑ No <br /> Name of CUPA,authorized agency, 761 <br /> g cy,or LIA: <br /> TITLE OF CERTIFIER 755 <br /> If certifier is other than CUPA/LIA check appropriate box below: 762 <br /> ADDRESS 756 <br /> ❑ a. Certified Industrial Hygienist(CIH) <br /> ❑ b. Certified Safety Professional(CSP) <br /> CITY 757 ❑ c. Certified Marine Chemist(CMC) <br /> ❑ d. Registered Environmental Health Specialist(REHS) <br /> PHONE 758 ❑ e. Professional Engineer(PE) <br /> ❑ f. Class II Registered Environmental Assessor <br /> DATE 759 CERTIFICATION TIME ❑ g. Contractors' State License Board licensed contractor (with <br /> hazardous substance removal certification) <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763 <br /> (8 yea,the taM interior allnosphwe shell be red'rerkerl with a combustible gas indicator prior b Wolk being conduced on the tank.) Yes ❑ No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 764 <br /> A copy of this certificate shall accompany the tank to the recycling/disposal facility and be provided to the CUPA M there is no CUPA,copies shall be submitted to the Lb1 and <br /> authorized ;owner/operator of the tank system removal contractor,and the recycling/disposuil facility. <br />