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06/02/2005 10:13 FAX 510 614 8396 PARADISO MECHANICAL Z010 <br /> 05/31/2005 09:13 FAX 510 614 83 PARADISO MECHANICAL ID002 <br /> tTNIVM PROGRAM CONSOLIDATED FORM <br /> B AZARMOUS WAM <br /> =HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> o <br /> 1. FACHMEY MENTMCATION <br /> codecs es) 3 BLFACIIdTY ID$'S�55 NAME l5.me u sdC[LrrY PiAi�yr rrttA- Die <br /> r•r <br /> 7a0 <br /> TANK OW7M NAME <br /> TANK owNM ADDRFSS <br /> v 7" <br /> TAMC OwNER CITY 742 $TATb 749 z>P CODE ^y� <br /> H. TANK CLOSURE WFORMA,'IOIti <br /> Tank ID# Coocen¢atiom of Flammable Vapor Concenmtion of Oxyg- <br /> (Aaach.ddlJovl cope <br /> aE dus page For mint mRn TOPCeuQr Bottum Top Centet lgntmm <br /> TANK Gttoc WM1kO) 7e5 B 746a 7 a 7460 P 747a 7a7b r 7e7c <br /> INTERIOR I ��/ �� Q� <br /> ARREEADDIINNGS EM 74 6 7491 47' <br /> 7 /) 749c �!� 7lOe '� 7506 A 730e <br /> 731 7 75M 7520 793. 759b 7$9e <br /> 1B, cy-RTMCATION <br /> On rxam,mthoa of he rank,I certify the®nlr i9 vigrally fmt Pram pmduct,stodge,scale(tl1w,flslq rosidual of mnk con--),nns-le and debris. I f0ther cm4fY <br /> dlgr fllc information provided herein is rue and accurate to the best of MY Imouledge_ <br /> SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> 760 <br /> Certifier is a izprascbmdya of rhe CUPA,nuthnn2ed agency.or LIA•, <br /> NAME OF CER?= (Prkr) <br /> add Cl Yes O No <br /> 761 <br /> Neste of CUPA,mahonud agency,or LIw: <br /> 7ss <br /> TITLE OF CERTIFIER 70_ <br /> If eatlflar is other[has CUPA/T iA check apptoPrinm box below= <br /> 756 <br /> ADDRS Ela. Certified Industrial Hygienist(CIM <br /> ES <br /> Q h- Certified Safrryy (CSP) <br /> CITY 7,57 c. Cerlificd Marine C.hami9t(CMC) <br /> ��� ❑ d. Rcg=Ted E;uviroamenwl Hcaldt Specialist(REHS) <br /> PHONE 736 ❑ e. Professional BUvT er(PI;) <br /> y/G� ��� p Q�� ❑ f. Ctass II Registered Environmental Asseagof <br /> DATE 759 CERTIFICATION TIME ❑ s- Contractors'Smra license Board licenced conuaemr(with tlA"rdous <br /> substance rcmaval t:ertification) <br /> 753 <br /> TANK PRP.VIOUSLY HELD PlAMMABLE OR COMBUSTIBLE MATER A.LS <br /> al7m.Olt tank Interlur amwpbere�.0 he re-r�wife a Comb06rible Zs irdimw prior w work being con6ueud an Wo DEAL) ❑ Yea ❑ No <br /> GEIRTiplEX'S TA'MMAI\.AClEl,=L%IMUCTIOh'S FOR SCRAP DEALER,DIMSAL FAI-'M -ETC: 7th <br /> Awd <br /> A ropy of dris catifiatc 5h.n xoornp3ay the tank co�e rxyClmE!dl gtoeal bd11ry anti be ptirvide.r m rhe CLIA_ If ch=i!na CUPA,copies shall be submiuW to tM UA led <br /> � m'�a,fY nr 11tL• V nrrdernr 171[t V <br /> UPCF(12/99) 39 Formerly DTSC 1249(6/98) <br />