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OZ/03/2006 13: 21 FAX 510 614 8396 PARADISO MECHANICAL 10010 <br /> 010`13/2006 07:43 3165231' ADAMS SERVICES 10. PAGE 11 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZA"OUS WAS'T'E <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Rego I of 1 <br /> I.FACILITY IDENTIFICATION <br /> BUSINESS NAME(M-an;r•AGr1.TY t4AMS or DSA-Doing Stlelney.Aa) 3' FACIUT-Y ID& 1, <br /> ARCO 400593 - 6100 N. HIGHWAY 99; STOCTCWN, CA 95212 <br /> TANK OWNER NAME 740, <br /> Si EE+h-Oft PRe5ffe'F6 US <br /> TANK OWNER ADDRESS 741. <br /> TANK OWNER CITY 44GU&-GN 742 5TATE --IPA 743 ZTP CODE -11-1665.J582 74a. <br /> 11.TANK CLOSURE INFORMATION <br /> Tank fD" ConcantrnUon of Flammable Vapor Concentration of Oxygen <br /> Waeh odditionPl ooplas <br /> r—zonTANK of��V imus n mm TOP trcnlct 91(tnm Top Center Bottom <br /> TN7E1t1OR 735. 746.. 74th 7a>ic. 747x. 747b 747c, <br /> ATMOSrII� I 58818 C� c� 20.9 20.9 20.9 <br /> READINGS 2 58819 7AL Cg 749L Ca 7496. 0% 74%. 201.9 75a.. a).9 75111 ' 2D.9 7511b. <br /> 3 58M 7S 1. 0% 792i 7521, 752c. 20.9 753x- 7331,. 7531, <br /> III. CERTIFICATION <br /> On eaaminalion of the tank,t cern Cy the tank is ally free from produ"sludge,ogle(chin,flaky residual of tank conlems),rin7777 and debris.I further certi- <br /> fy that t)1E itsfortaationmvldcd hereto is d at tartare to the best of my knrnvledge, <br /> SIA RFIFT73R STATUS OR AFFILIATION OF CURTIFYINd PERSON <br /> Certifier Is a representative of the CUPA,aulhorized agcocy,or LIA; 7'50- <br /> _hfE O (Pont) 7Sa• ❑ Yes No <br /> HENRY M. SOR NSEN Nwe of COPA,autherixad agency.at LIA, 761, <br /> TrTLE OF CRIMFIER 755, N/A <br /> MARINE CHEMIST If certifier is othor than CUPAILIA check appropriate box bdaw; 762• <br /> ADDRESS 756 El n. Cerii6ed Industrial FIygienist(GTN) <br /> 23358 MAUD AVE. ❑ b. 6e timed Safety Professional(CSP) <br /> CITY 757 e, Certlfled Marine Chemist(CMC) <br /> HAYWARD, CA 94541 ❑ d_ Registered Environmental Health Specialiot(Reh15) <br /> PHONE 756. O e. Pmfu%iional Engineer(PE) <br /> 510-583--0075 ❑ L CI9Cc Il Reside"Environmental Assessor <br /> DATE 759. CERTIFICATION TIME Cl S. CmltractorS'Seitc I.lc&mc Hoard Ilcmacd contractor(with <br /> hazardous substance removal catifimtion_ <br /> T K PRXVIOT JSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763. <br /> (If yea,ilio tank Intortor.tramphare shall be rr-checked+Lith a combustible gnr indic.torprier to work keine compicicd on rhe rank) YLS ❑ No <br /> CE IER'S TANK MANAGE N�v�INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC- 764. <br /> ASCO ROAD t ANI F ZL- <br /> 400.1 N. VASCO ROAD TANKS4PIPING X=T5 TITER 22 MUIRFMENi'S <br /> LYVMORE, CA 94550 CRUSH WITH IMAVY SQUTMF.NT <br /> A copy of Na certificate slidl accompany the tank to the recycling/disposal facility and be provided to the agcacy u�crsecing tank closure 0x.CUPA or other <br /> authorized local agency);Ute owner and0or operator of the tank 5ystam;and the lank ramoval co"=ctor. <br />