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UNIFIED PROGRAM CONSOLIDATED FORM <br /> ..I.A-'�'AR-3I2-i-3s-�$3'-t"-crs'i'E <br /> IiAZARI)OIJS WASTE TANK CLOSURE CEIBTIFICATION <br /> _ Pa ,e 1 of 1 <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME (Same as FACILITY NAME or DDA — Doing nosiness As) 3 FACILITY IDN 1 01 1 8 1 6 1 9 <br /> Stockton Steel (CERS Number) <br /> TANK OWNER NAME <br /> 0 <br /> Stockton Steel <br /> TANK OWNER ADDRESS 41 '. <br /> 3003 East Hammer Lane <br /> TANK OWNER CITY Stockton 742 STATE CA 743 ZIP CODE 95212 744 <br /> II. TANK CLOSURE INFORMATION <br /> Tank ID N Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> of this page for more man To Center Bottom To Center Bottom <br /> TANK mreemnks) P p ',. <br /> INTERIOR 1 745 746a 7466 746c 747a 7476 >47c <br /> ATMOSPHERE 001 D O�, .� <br /> READINGS 2 748 749a 7496 749c 750a 7506 750c ',.. <br /> 3 751 752a 752b 752c 751a 7531 753c <br /> M. 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 further certify that , <br /> the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF ER 4R STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Certifier is a representative of the CUPA, authorized agency, or LIA: 70 <br /> 54 <br /> NAME OF CE T'IFIER (Pang ❑ Yes No <br /> ROBERT MARTY Name of CUPA, authorized agency, or LIA: 761 <br /> 'TITLE OF CERTIFIER 755 San Joaquin County Enviro Health Dept <br /> PRESIDENT/ADVANCED GEOENVIRONMENIAL, INC. If certifier is other than CUPA / LIA check appropriate box below: 762 <br /> ADDRESS 756 <br /> ❑ a. Certified Industrial Hygienist (CIH) <br /> 837 SHAW ROAD ❑ b. Certified Safety Professional (CSP) <br /> CITY 757 <br /> ❑ c. Certified Marino Chemist (CMC) <br /> STOCKTON <br /> ❑ d. Registered Environmental Health Specialist (REBS) <br /> PHONE _ 758 ❑ e. Professional Engineer (PE) <br /> 800-511-9300 <br /> ❑ T. Class Il Registered Environmental Assessor <br /> z59 ® g. Contractors' State License Board licensed contractor (with hazardous <br /> DATE CERTIFICATION TIME <br /> substance removal certification) 6817227 A-HAZ <br /> 10/01 /2019 <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS763 <br /> (Diesel fuel) <br /> (Ifyce, the tank interior atmosphere shall be re-checked ends a combustible gas indicator prim to took being canducted on the tank) DQ Yes ❑ No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY, ETC' 764 <br /> Tank has been rinsed . Tank previously contained diesel fuel . <br /> T�y ��MI� aj2 1Z C <br /> A copy ofthis certificate shall accompany the book to dterecycling / disposal facility and be provided to the CUPA If there is no CUPA, copies shall be submitted to the LIA mid authorized <br /> iter / operator of the tanks stem removal contractor acid the recycling / disposal facility. <br /> UPCF (12/99) 39 Formerly DTSC 1249 (6/98) <br /> i <br />