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UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS WASTE HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Page of I. FACILITY IDENTIFICATION BUSINESS NAME(Same a FACILITY NAME or DBA—Doing Business As) 3 FACILITY ID# 1 D & L Farms, Inc. TANK OWNER NAME 740 D & L Farms, Inc. TANK OWNER ADDRESS 741 191 S. Beacon Island Road, Stockton, CA 95219 (P.O. Box 620, Linden, CA 95236) TANK OWNER CITY Modesto 742 STATE CA ZiP CODE eaase 744 743 H. TANK CLOSURE INFORMATION Tank ID# Concentration of Flammable Vapor Concentration of Oxygen (Attach additional copies of this page for more than TANK three tanks) Top Center Bottom Top Center Bottom INTERIOR 745 746a 746b 746c 747a 747b 747c ATMOSPHERE 1 10,000 diesel AST <5% <5% <5% 20.9%No dry ice 20.9%No dry ice 20.9%No dry ice READINGS 748 749a 749b 749c 750a 750b 750c 2 10,000 diesel AST <5% <5% <5% 20.9%No dry ice 20.9%No dry ice 20.9%No dry ice 3 751 752a 7526 752c 753a 753b 753c 2-H-1,000 diesel ASTs <5% <5% <5% 20.9%No dry ice 20.9%No dry ice 20.9%No dry ice III. CERTIFICATION 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 the information provided herein is true and accurate to the best of my knowledge. SIGNATT'RE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON Certifier is a representative of the CUPA,authorized agency,or LIA: 760 NAME OF CERTIFI Print) 754 ❑ Yes ❑ No Terry D, Hamilton Name of CUPA,authorized agency,or LIA: 761 TITLE OF CERTIFIER 755 Gen. Eng. Haz. Waste Cont. Lie. #339108 Ifcertifier is other than CUPA/LIA check appropriate box below: 762 ADDRESS 756 ❑ a. Certified Industrial Hygienist(CIH) 1502 Westbrook Court ❑ b. Certified Safety Professional(CSP) CITY 757 ❑ c. Certified Marine Chemist(CMC) Modesto, CA 95358 ❑ d. Registered Environmental Health Specialist(REHS) PHONE 758 ❑ e. Professional Engineer(PE) (209) 404-7700 ❑ f Class II Registered Environmental Assessor 7,59 DATE CERTIFICATION TIME E g. Contractors'State License Board licensed contractor(with hazardous 1/8/2026 3:00 PM substance removal certification) rK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763 the tank interior atmosphere shall be re-checked with a combustible gas indicator prior to work being conducted on the tank.) X Yes ❑ No CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 764 AST's remained on-site. Hazardous waste liquids / Rinsate transported for disposal under a CA Uniform Haz. Waste Manifest and was performed by George W. Lowry, Inc., 4632 Kiernan Court, P.O. Box 176, Salida, CA 95368 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 agency; ner/o rator of the tank s stem removal contractor and the recycling/disposal facility. UPCF(92/99) 39 Formerly DTSC 1249(6/98)