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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Page of <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3. FACILITY ID# Q Q 2 9 3 1. <br /> Olin Chlor Alkali Products <br /> TANK OWNER NAME 740. <br /> Olin Chlor Alkali Products <br /> TANK OWNER ADDRESS 741. <br /> 26700 South Banta Road <br /> TANK OWNER CITY Tracy 742. STATE CA 743. ZIP CODE 95304 744. <br /> II. TANK CLOSURE INFORMATION <br /> Tank ID# Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> of this page for more than <br /> TANK three tanks) Top Center Bottom Top Center Bottom <br /> INTERIOR I TK307A 745. 746a. 746b. 746c. 747a. 7476. 747c. <br /> ATMOSPHERE <br /> READINGS 2 TK307B 748. 749a. 749b. 749c. 750a. 750b. 750c. <br /> 3 TK307C 751. 752a. 752b. 752c. 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 further certify that <br /> 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 (Print) 754. El Yes ® No <br /> Name of CUPA,authorized agency,or LIA: 761. <br /> TITLE OF CERTIFIER 755. N/A <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 75S. El e. Professional Engineer(PE) <br /> ❑ I. Class II Registered Environmental Assessor <br /> 759. El g. Contractors'State License Board licensed contractor(with hazardous <br /> DATE CERTIFICATION TIME 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.) ❑ Yes ® No <br /> CERTIFI ER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 764. <br /> The Safe Work Permitting process will address any safety and health issues associated with the cutting of the tanks.These tanks have <br /> never contained flammable materials and are open to the atmosphere. Olin will be utilizing UCI Construction,Inc.to perform the <br /> work. <br /> A copy of this certificate shall accompany the tank to the recycling/disposal facility and be provided to the agency overseeing tank closure(i.e.CUPA or other authorized local agency); the <br /> owner and/or operator of the tank system;and the tank removal contractor. <br /> UPCF IIWF1249(1/99)-1/2 www.unidocs.org Rev.02/16/00 <br />