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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Pae 1 of I <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME (Sante as FACILITY NAME or DBA — Doing Business As) 3, FACILITY ID# ( 1110 111 1 513 1910151 1 CERS IDI* <br /> San Joaquin Delta College <br /> 740, <br /> TANK OWNER NAME <br /> San Joaquin Community College District <br /> TANK OWNER ADDRESS 74t . <br /> 5151 Pacific Avenue Lt ? 2Qz � <br /> TANK OWNER CITY Stockton 7az. STATE CA 743' ZIP CODE 95207 744. <br /> H. TANK CLOSURE INFORMATION <br /> Tank ID # Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> ofthis tefortnorethin <br /> hrTop Center Bottom TOP Center Bottom <br /> duce tanks) <br /> ` Room 745, 746x, 746b, 746x, 747m 747b, 747x. <br /> TANK 1 148 ' N/A N/A N/A N/A N/A N/A <br /> INTERIOR Transfer <br /> ATMOSPHERE Sump <br /> READINGS Room 748. 749x, 749b, 749x. 750s. I 750b, 750x. <br /> 2 151E - N/A N/A N/A N/A I N/A N/A <br /> Collectio <br /> n Tank <br /> 3 751 . 752a, 7526. 752x. 753x. 753b. 753x. <br /> III, CERTIFICATION <br /> On examination of the tank, I certify the tank is visually free from product, sludgerscale{thin Aadu 1,nnseate and debris. I further certify that <br /> the information provided herein is true and accurate to the best of my knowledge. ' >C'L Ccrtiticr'� Tank Management Instructions <br /> SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Mark. M Uv( j t-i, Certifier is a representative of the CUPA, authorized agency, or LIA: <br /> 760. <br /> NAME OF CERTIFIER (print) 754. ❑ Yes ® No <br /> Mark Milani , RE (CE 35120 expires 9/30/2019) Name of CUPA, authorized agency, or LIA: 761 , <br /> TITLE OF CERTIFIER 755. N/A <br /> Environmental Services Manager - Milani & Associates If certifier is other than CUPA / LIA check appropriate box below: 762. <br /> ADDRESS 756. ❑ a. Certified Industrial Hygienist (CIH) <br /> 2655 Stanwell Drive, Suite 105 ❑ b. Certified Safety Professional (CSP) <br /> CITY 757. ❑ c. Certified Marine Chemist (CMC) <br /> Concord ❑ d. Registered Environmental Health Specialist (REHS) <br /> PHONE 758. ® c. Professional Engineer (PE) <br /> 925-674-9082 ❑ f. Class 11 Registered Environmental Assessor <br /> DATE 759, CERTIFICATION TIME ❑ g• Contractors State License Board licensed contractor (with hazardous <br /> substance removal certification) <br /> January 18, 2018 2:30 prn <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763. <br /> (If yes, the tank interior stotosphere shall be re-checked with a combustible gas indicator prior to work being conducted on the tank.) ❑ Yes ® No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY, ETC: 764, <br /> Transfer Tank, 5- allon Polvethylene - Dispose of as Non-RCRA Hazardous Waste (Waste Code 541 ) * <br /> Collection Tank, 30 gallon Polyethylene - Dispose of as a Non-RCRA Hazardous Waste (Waste Code 541 )* <br /> Tanks & >I-.toced of as Non-RCRA I-IXV as not all surface scale on interior walls of tanks was able to be removed. <br /> UI1CF HR F1249 (1 /99) - 1 /2 www.umdoes.org Rev. 02/ 16/00 <br />