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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Put, or <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME( . -FAFACILDY—NAME or DBA-Doing Bodo.AA 3 FACILITY[D# .— _} <br /> J.R. Simplot Company, Attn; John Pallen (559)439-3900 PO Box 28955, Fresno to 6 L.. _ <br /> TANK OWNER NAME <br /> _ieo <br /> Giannnecchini Company MAY 2 7 2016 <br /> TANK OWNER ADDRESS --- - , r'lnlpsrM� lel <br /> 7707 S. Jade Tone Rd. " . W._- <br /> g'( OWNF.RCITY 742 ,STATE 741 ZIP CODE 7'10 <br /> IL TANK CLOSURE INFORMATION <br /> 'rank ID# Concentration of Flammable Vapor Concentration of Oxygen <br /> (Atwc eAdhmnAl mio. ._ <br /> orthirpwfor=mtlmn Top Center Bottom Top Center Bottom <br /> TANK _ <br /> INTERIOR 1 745 74" 7466 746c 747, 7476 ^747, <br /> ATMOSPHERE UN32 Pre-Cleanings NH3 NH3 NH3 6 I� Q am Q,7 <br /> READINGS Z 141 —_... 744% ...._.-]49E. 'l4vc. C711 --_� ._75ob 75ac <br /> UN32 Post Cleaning NH3 �— NH3 NH3 ZD, ` If Ali <br /> 751 753. 7526 752- 753. 7556 755, <br /> III. CERTIFICATION <br /> On examination at the lank.1 certify the tank is visually free from product,sludge,scale(thin,Flaky residual of tank contents),rinseate and debris 1 further certify that <br /> the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATU OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Certifier is a representative of the CUPA,authortzed 7t'0 <br /> agency,or LIA: <br /> NAME OF CERTIFIER o,nnt 750 ❑ Yes N No <br /> Doug Killian (Lic# 613706) Name of CUPA,authorized agency,or LIA 761 <br /> TITLE OF( FR HFIER755 <br /> Project Manager/MP Environmental Svc If certifier is other than CUPA/LIA check appropriate box below 702 <br /> ADDRESS - -" 756 ❑ a. Certified Industrial Hygienist(CIH) <br /> 3400 Manor St ❑ b. Certified Safety Professional(CSP) <br /> CI'Il ❑ c. Certified Marine Chemist(CMC) <br /> Bakersfield CA 93308 ❑ d Registered Environmental Health Specialist(REHS) <br /> PHPHONE58 ❑ e. Professional Engineer(PF:) <br /> 661-340-0825 ❑ f Class 11 Registered Environmental Assessor <br /> 75a ® g. Contractors'State License Board licensed contractor(with harnrdous <br /> DATE CERTIFICATION TIME substance removal certification) <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE:MA'rERIALS <br /> ]63 <br /> (Ilya.the t=k miarmr atmosphere droll be redm-ked with.cambumtbl<ps mG-.tor pnor to work bemg a ndtteted on ffic xlA i ❑ No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL.FACH ITY.ICIC 764 <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 /> A copy ofthis certificate shall wcominuty the tank to the recyding/dispe.al fm:ilay and be provided io the CUPA. Ifthere is no CUPA copies Ahall be.rubntined to the LIA and eofl orf4ed <br /> site y owner/operator o([he ttadt Sysienc removal contractor and the raychng_dim nal tkoky-___, <br /> UPCF(12/99) 39 Formerly DTSC 1249(6/98) <br />