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UZiUJiZUUU la:ZZ SAA 510 614 8396 PARADISO MECHANICAL U 014 <br /> 01,"13/2006 07:48 3105231E ADAMS SERVICES 4C, PAGE 15 <br /> l <br /> . UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS 'WASTE TANK CLOSURE CERTIFICATION <br /> Page of z <br /> L FA.C.rrY IDENTIFICATION <br /> AUSINESS NAME(same as FACILITY NAME or DBA-Daiog HUllrnall A0 3' FACILITY IDM I 1 1. 1 1 1 1 1 1 T I <br /> 1. <br /> ARCO #00545 , 6100 N. HIGI-WAY 99; STOCRTON CA 95212 <br /> TANK OwNM NAME 740, <br /> TANK OWNER AT)DRPSS 141. <br /> TANK Ou/NER CITY -if3T3frT-$T►4• 742 STA1 3 -FA 743. ZIP CODE 744• <br /> H.TANK CILOSM INFORMATTON <br /> S°Yi 10 v Concmtratiou of Ilairtmabla Vapor Concentration of Orygen <br /> elr addhluad 000do <br /> im otthu ptn T than Tbp C&M-Ir bottom Top Center 330ttnm <br /> INTERIOR 745- 7K.n. 7466. 746c� 7a7n. 747b. 7a7c <br /> ATMOSPHERE 1 58821 <br /> READINGS 2 Ida. 749n. 7496. 749e, 7502 75rtb. 7410b <br /> 9 751. 7S2i. 757b. 7S7L. 753a 753b. 733b, <br /> III_CERTIFICATION <br /> On examination of the tank,7 comfy the tank Is visually fief from product,sludgy auilo(dtin.flaky residual of tank mntcnLs)•Tin?777 and debris I further certi- <br /> fy that tho ink mallon ptm ided hmin iv mte and accurate to the bcsl of my knowicdgc. <br /> SIGNATURE OF UZMFIER STATUS OR AFFILIATION OF CHR'I7FYING PERSON <br /> '•,�,�- .�,• %�,t,-. tt"• Ccrrifia is a represcntrnivc of rhe CUPA,authorized agency,of LTA- 7E0. <br /> r `. <br /> NAME OF CERIgIER(Prim) ❑ Yes �I No <br /> 14 Z n Name of CUPA,audxvu sod agency,or L1A: 76t. <br /> TITLE OF CERTIFIER 7X� N/A <br /> 1`1ARINP1 CHR,41ST Tf urrifcr 1n olhcr thatt CUPAILI A ch=k appmpclnta hex below-, 762. <br /> ADDRESS 75e. ❑ a. Ccrtificd laduatriol Hygienist(CII) <br /> 23350P MAUD AVE. ❑ b. Certified Safety Prvfcssional(CSP) „ <br /> CITY 757. e, Certified Mnrine Chemisr(0-MC) <br /> HAWARD r CA 94541 a d. RcgutaTed Envirpumental licalth Spccialist(RENS) <br /> PHONE 758• ❑ r; Prufcssional Engineer(PE) <br /> 5103-583--0025 O f, Class II Registered Envitonmt tul Asscsaor 4. <br /> DATE 759. CERTIFICATION TIME ❑ g, Contractors'State Ucensc Board llctmed conauctor(with <br /> hazardous subvtance removal certificaticm_ <br /> TANK PREVIOUSLY FIELD FLAMMABLE OR COM13UMDLE MATSRIAL5 7st• <br /> M <br /> (If yee,the lank interim wtni&Rphem shat]be m-chmlmd with n comboUbla gu indfedtor prlor to Work Mnt;eompined an Ihu Innk•) -X Yca 0 No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACTI-rrY,ETC. 7" <br /> MASCO ROAD LANDFIU <br /> 4011 N. VA5CQ ROAD TANKSIPIPING MEETS TITLE 22 REQUIREMENTS <br /> L IVERM.O.RE, CA 94550 CRUSH WITH HEAVY EQUIPMENT <br /> A copy of this certificate shall accompany the lank to the tccyclinVdivposa1 facility and be provided to the 5gcnty ovc"ccing tank el=re(i.e.CUPA or other <br /> authoritod Iocil agency);tho owner and/or operalor of rhe tank Syvtem;and tho tank removal eowmctor. <br />