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� . <br /> UNIFIED PROGRAM CONSOLIDATED FORM -' <br /> I� <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION 19 2015 <br /> ENVIRON .EALTH <br /> _„t <br /> 1. FACILITY IDENTIFICATION DFPAF TMENT <br /> BUSINESS NAME(Same.FAf'IL1717Y NAME or 06A-IMinx Buaiaess As) i FAeft iA ID# <br /> J.R. Simplot Company, Attn; John Pollen i(559)439-3900 PO Box 28955, Fresno GA 93729 <br /> TANK OWNER NAME 7411 <br /> Giannnecchini Company <br /> TANK OWNER ADDRESS - - <br /> 7707 S. Jack Tone Rd. <br /> S�OWNER CrIY '. 7.w <br /> r _ �,�SIAIT� 74 i fIPCY)I}Ii <br /> [[_ TANK CLOSURE INFORMATION <br /> I'ank II)q Concentration of Flammable Vapor ! Concentration of Oxy n <br /> (Misch addamnal mutes l L� <br /> "f this parte fix niore than - i <br /> TANK thrfttard,x) Top Center Bottom Fop Center Bottom <br /> 1N17F;RIM 1 745 74ea - 14eh 746e 747a - 7576 �.. - A7d7c <br /> F:A <br /> X1MU.OSPHEUN32 Pre-Cleaning NH3 '6- NH3 � NH3 t�� <br /> RDINOS 2 74$ 7414 7414h � 74tic � �_ 7sn,t +�� � 75nh <br /> UN32 Past-Cleentnp NH3 -0 NH3 NH3 +fir <br /> 7tt 75:a 7s7t, Sit ?d <br /> III. C'ERTIFIC'A"I'ION <br /> On examination ofthe tank.1 certih the tank is visually free tiom product,sludge.scale fthin.flaky residual oftank contents),rinseate and debris I turther ceruilk that <br /> the information pros ided herein is true and accurate to the hest of m% knowledge <br /> - i <br /> SKWAR 'OFF('I <br /> /•'R-ITFIFR ti I A'IT IS OR AFFIIJA'110IN OFC]-'RTIFYIN(I PERSON <br /> Certifier is a representative nfthe CI IPA authorimd agency.or I.IA Nr <br /> NAMI'.OF(TRTlFII-R (Fxinu °5•t <br /> ❑ Yes ■ tit. <br /> Doug Killian (Lic# 613706) Name of('IIPA,authonzedagctic%.oiLIA <br /> TTTT F OF C'FKTTFIFR <br /> Project Manager/MP Environmental Svc Ifcertifier is other than CI JPA i I.IA check appropriate box below lir <br /> I ADDRESS ❑ u Certified Industrial INgtemst Willi <br /> 3400 Manor St ❑ h Certified Safety Prcofessional(CSP) <br /> TK:7 <br /> C HY ❑ c Certified Mat ine Chemist WNIC'1 <br /> Bakersfield CA 93308 [] d Registered F.nvtronmcntal Iiealth Specialist(RVIIS) <br /> PIIIONF 4 ❑ e Professional F-ngtnecr(PI•,) <br /> 661-340-0825 ❑ f Class If Registered I-,n%ironniental As."sol <br /> 7" ® g Contractors'State license Board licensed contractor(with havardous <br /> I)A"I7. ('I:R"nFTC'A'i"I()N'TTMI substance removal cen ficutioro <br /> TANK PRFVIOCISLY IIFI,I}FI.AMMABI.F OR COM IS"T'IRI.I.MA-ITRIAI S <br /> flfyea the tank uumot atrtwphere shall be to-_+wk d with a amthtuuhle gas mdicatm prior to work hesng runducied on thr tani,) Q Ye-s ® No <br /> CI?R"TTFIFR S TANK MANACiI{ItiII:NT INSTRI I('9TONS FOR SCRAP DFALF-R.DISPOSAI FAC'ILI-ne,FI'C <br /> Tank formerly contained UN32 (Urea Ammonium Nitrate) liquid fertilizer. This tank has been cleaned <br /> of all product residues, rinse and has been purged and closed for safety. Disposition of this tank is up <br /> to the owner. It is not being removed at this time. <br /> fA copy u1'Shis ccrtificale shell aQcumpam the intik to the r=, disposal fncalm and be pr,,vxled it)the(`I PA If there is no('t IPA,cs+plea shall in.ubiturted to the I 1 and authmir_ed <br /> agatuy;uwnar operator cit-the tank system,renumal conitachrt,and the recyclntg disp)-ml facility <br /> [TPC'F(12/99) 39 Formerly DTSC 124()(6'98) <br />