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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Pae of <br /> L FACILITY IDENTIFICATION <br /> BUSINESS NAME(Same as FACILITY NAME or oe —og ausmess As 3 FACILITY ID# 1 <br /> �S L► I,e,,o <br /> Arco Facility #0760 aL ori 1 . CA 9±�a4a1 <br /> TANK OWNER NAME 740 <br /> Arco Products Company <br /> TANK OWNER ADDRESS 741 <br /> 4 Centerpointe Drive <br /> TANK OWNER CITY La Palma 142 I STATE CA 143 ZIP CODE 906231066 744 <br /> Ii. TANK CLOSURE INFORMATION <br /> Tank ID# Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional _ <br /> `°pies of this page In To Center Bottom To Center Bottom <br /> TANK more than three tanks) P P <br /> INTERIOR745 746a 746b 746c 747. 747b 747c <br /> ATMOSPHERE <br /> READINGS 7748 749a 749b 749d 750a 750b 7500 <br /> 3 751 752. 752b 7520 753a 753b 753c <br /> III. CERTIFICATION <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 LIA: 760 <br /> NAME OF CERTIFIER (Nm) 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 <br /> ❑ e. Professional Engineer(PE) <br /> ❑ f. Class II Registered Environmental Assessor <br /> DATE 759 CERTIFICATION TIME El g. Contractors' State License Board licensed contractor (with <br /> hazardous substance removal certification) <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS lea <br /> Is yea,the tank miamo amsaphere shall be reA al with a oafnWstible gat indioeta prior to work being corkuctetl on iha tank.) Yes ❑ No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 764 <br /> A copy of this certificate shall acrwmpany the tank to the recycling/disposal facility and be provided to the CUPA If there Is no CUPA,copies shall be submitted to the ILIA and <br /> authorized ovaher/operator of the tanks ;removal contractor,and the recyclina/disposal facility. <br />