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r <br /> UNiI<ic'WD PRd�COIliBIgLIUATM 16apm <br /> HA URDOUS FASTS' <br /> HAZARDOUS WASTE TANK CLOSURE CERTMCATYON <br /> IL FACUXry mErMCA.TI N <br /> BILCINFSS NAME(Same m FAC U Y NAMHa DDA-Dmrg 9wlnest At) 7 FACl1ITY IDS ¢T137- JDI 0101 <br /> l <br /> TANK OWNER NAME rre <br /> TANK OWNER ADDRESS 7,t <br /> A fl ao r <br /> TAIAXOWI AB'CITY 742 STE 743 it <br /> CO"1r 7 t7 7 <br /> r <br /> U. TANK CLOSURE INFORMATION <br /> Tank M A ConcenCabon of Flammable Vapor Cancetttratton of Oxygen <br /> TOM °"a0��o"" Top Center Bottum Top Center Bottom <br /> INTERIOR <br /> AT1tit7 E I 743 74l1 �p <br /> ,% 74be �Qj rbc Ta7a rasa ran <br /> d O + <br /> RHApiAFGS 746 74% 7196 f p74 <br /> 9c �� 19 756a700 <br /> 7117 0,7,b 210Ao 7526 753a yCi (}„1j e•. <br /> 7"4+4 <br /> LII. CERTMCATTON <br /> J On exVmtrhation of the umk,I cemfy the tank is visually free from product stodge,scale(thin flaky residual of tank contents), nnseate and debns I further c dify <br /> that-the information provided herein to orae and ac=rxto to the best of my kaowledga. <br /> SIGLVATbRE OF Tif IEA STATUS OR AFFMIA71ON OF CERTIFYING PERSON +I <br /> for r-A50k (.'rml%r s59mC <br /> " 9t: box a the CLIFA,sut u=xd a8w=.Y,or LIA. 760 i <br /> NAME OF CER W 'Yes Tiv <br /> ( <br /> Name,of CUPA,authorized agency,or I.IA 7It <br /> TILE OF CERTIF(ER 755 NIA <br /> If carttfier Is other than CUPA I UA check appropriate box below 762 <br /> ADORMS ' <br /> ����yy � `' 36 ❑ s. Certified lzuluatrial HyStentst ICHD <br /> t 140�'1 rTad b CCxtAvtd wety vk # ionaS 4CEp) <br /> CITY 7" <br /> Q e Certified 14fartna Cttcmist(DC7 <br /> 1)jY".%J ❑ d Registered E rvirontnetltal Health Specialist(REES) <br /> PRONE 751 a Professm al Engineer(PE) <br /> 'WE-272g? f Oass.nRrg 0eizil—r-- n rrrml Aasrsanr <br /> j 735 CERTIFICATION IFICATfON TIME % Ctsi,tstie m*s' Seal.L.ajIr_m l,aarA htansi✓1 eraturacwt Swtth hmudoua <br /> substanceCer <br /> removal ttfiradon) <br /> - 1. 00 Cl -C I <br /> rAKK PRL, 4wuSLY mELU FLA&%L kaLE oR comBy u 7 LE.vA 7zuu s <br /> (It ya Owtmk fa isr=stawpba shun M n"*aftw wish a 9mviti"11)w as,xig4uw plot to sWIL�ai txuftizM t to atcvA ) PL Yea 0 ,go <br /> CER'III�'IER'sTA.%-KmAvAGzmMvriNsmCXM0NS'FOR SCRAP�tLER,MS'POSAL PriCaXrY,a= <br /> �, artj "per Of koz sbk; Wfm"p-&fes <br /> On. 11 /02/00 Forward Landfill recei-ved tw L (6-5 torsl of <br /> Fiberglass debris from W.A. Crai 1rn <br /> A ropy of this"run etc shtt1 aceompany the tank to the mmycltng i dapowl facility AM be provided to the C to u no CUPA,e0vin shall W submitted to sh�LlAllnd <br /> } <br /> UPCF(1f99) 201 Formerly DTSC 1249(6198) <br /> ° <br />