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UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS WASTE <br />HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br />Page of <br />L FACILITY IDENTIFICATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) 3 <br />FACILITY ID# <br />I <br />Pick-n-Pull Auto Dismantlers Stockton LLC <br />CERS ID: 10183144 <br />TANK OWNER NAME 740 <br />Pick-n-Pull Auto Dismantlers Stockton LLC <br />741 <br />TANK OWNER ADDRESS <br />3027 Clark Drive <br />TANK OWNER CITY Stockton 742 <br />STATE CA 743 <br />ZIP CODE 95215 744 <br />II. TANK CLOSURE INFORMATION <br />Tank ID # Concentration of Flammable Vapor <br />Concentration of Oxygen <br />(Attach additional copies <br />TopCenter <br />Bottom <br />TANK <br />ofths pagthreetaanks)more than Top Center Bottom <br />INTERIOR <br />1 <br />745 746a 746b <br />746c <br />747a 747b <br />747c <br />Not Applicable: The tank was used for the CalRecycle Used Oil Collection Program. No <br />ATMOSPHERE <br />READINGS <br />2 <br />flammable materials were placed in the tank. All used oil was removed from the poly <br />sob <br />750c <br />tank and the tank disposed of as a Non-RCRA hazardous waste. <br />53b <br />753c <br />3 <br />HL 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 CERTIFIER <br />STATUS OR AFFILIATION OF CERTIFYING PERSON <br />Certifier is a representative of the CUPA, authorized agency, or LIA: 760 <br />❑ Yes ❑ No <br />NAME OF CERTIFIER (print) 754 <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 />❑ a. Certified Industrial Hygienist (CIH) <br />ADDRESS 756 <br />❑ b. Certified Safety Professional (CSP) <br />❑ c. Certified Marine Chemist (CMC) <br />CITY 757 <br />❑ d. Registered Environmental Health Specialist (REHS) <br />❑ e. Professional Engineer (PE) <br />-�R <br />PHONE <br />❑ f. Class II Registered Environmental Assessor <br />❑ g. Contractors' State License Board licensed contractor (with hazardous <br />759 <br />DATE <br />CERTIFICATION TIME <br />substance removal certification) <br />TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763 <br />(If yes, the tank interior atmosphere shall be re-checked with a combustible gas indicator prior to work being conducted on the tank.) (motor oil only) ® Yes ❑ No <br />CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY, ETC: 764 <br />Not Applicable: All used oil was removed from the poly tank and the tank disposed of as <br />a Non-RCRA hazardous waste. The tank was not recycled/scrapped. <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 LIA and authorized <br />agency; owner / operator of the tank stem; removal contractor; and the recycling / disposal facility. <br />UPCF (12/99) <br />39 <br />Formerly DTSC 1249 (6/98) <br />PNP0012766 <br />