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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> BUSINESS NAME(smsI. FACILITY <br /> ACILITY IDENTIF#ICAT_ <br /> ION <br /> oAMvDL #�usineasAFACILITY ID <br /> Arco Facility#0434 a . eP �, <br /> � J, LA p—k�Af <br /> i <br /> TANK OWNER NAME 740 <br /> Arco Products Company <br /> TANK OWNER ADDRESS 741 <br /> 4 Centerpointe Drive <br /> TANK OWNER CITY La Palm_ a 742 STATE CA 743 ZIP CODE 906231066 7" <br /> IL TANK CLOSURE INFORMATION <br /> Tank ID# Concentration of Flammable Vapor Concentration of Oxygen <br /> (Anarh additional <br /> espies aurisP <br /> tanks)antorr <br /> TANK re than three To Center Bottom Top Center Bottom <br /> me <br /> INTERIOR 11 745 7460 746b 74ac 747a 7471, 7470 <br /> ATMOSPHERE <br /> READINGS Z 74a 749a 749b 749c 7500 7501, 750c <br /> 3 751 752a 752b _752c 753a 7531, 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, 760 <br /> p g cy,or LIA: <br /> NAME OF CERTIFIER (Hint) 754 ❑ Yes ❑ No <br /> Name of CUPA,authorized agency,or LIA: 761 <br /> TITLE OF CERTIFIER 755 <br /> If certifier is other than CUPA/LIA check appropriate box below: 762 <br /> ADDRESS 756 ❑ 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(RENS) <br /> PHONE 758 ❑ e. Professional Engineer(PE) <br /> ❑ f. Class II Registered Environmental Assessor <br /> DATE 759 CERTIFICATION TIME ❑ g. ContractorsState License Board licensed contractor (with <br /> hazardous substance removal certification) <br /> 763 <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS <br /> (ayes,the t"interior almoWrI shall be rarhacked with a cuinbusd1,le gas indicator poor to work being m ucied on the Ian e) JU 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. If there is no CUPA,copies shall be submitted to the LLA and <br /> authorized en owner/operator of the tanks tem'removal contractor and the recycling/disposal facility. <br /> 0 � y <br /> i <br />