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FEB/24/2015/TUE 05: 16 PM WEI._ & SONS hAX No, "lUyt4i, r• iiU� <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Page 1 of 1 <br /> 1. ;FACILITY IDENTITICATION <br /> BUSFNBSS NA ME(Sema si YACk"TY)aA)vte a DBA-Do roe)3usi..ss As) 3• FACILITY ID* ' 0 0 0 . C, 3 7 8 9 0 0 t" <br /> Arco A1VUPM <br /> 740. <br /> TANK OWNIRR NANM <br /> Pacific West Petroleum Inc. <br /> Tat. <br /> TANK OWNER ADDRESS <br /> 550 W.Valpico Rd " <br /> TANK OWNER CITY Tracy 702 STATE Ca 7°s" ZIP CODE 95376 744 <br /> !U.",T'ANK:CLUSURE'LNFORMATIOIV <br /> Tank ID M Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> .[this pace ftrn a thea Top Center Bottom Top Carter Bottom <br /> TANK throe WW) <br /> INTERIOR 1 0520360 las. 0 7a6a. 0 746b. 0 74ac. 20.9 747e. 20.9 74x' 20.9 7d74 <br /> ATMOS <br /> )'I;HEERE <br /> READITr03 2 0520361 7th. 0 7491 0 749°. 0 749e. 20.9 7501 20.9 non. 20.9 7X;. <br /> 751, 7524 7s1b" 751a 753a. 753b. 75U. <br /> 3 <br /> tYIT. ,CERtIFICATION r <br /> On examination of the tack,I certify the tank it;visually free from product,sludge,scale(thin,flaky residual of tank contents),rinseate and debris. I further certify that <br /> the information provided herein is true and accurate to the best of my knowledge. <br /> — <br /> SIGN TIDIER STATUS OR"AFFILIATION OF CERTIFYINO PERSON <br /> 760. <br /> Certifier is a representative of the CUPA,authorized agency,or LIA: <br /> 7sa. <br /> N OF CERTIFIER (Pring C] Yee ® No <br /> 761. <br /> Kernet E_Wendt Name of CUPA,authorized agency,or LIA: <br /> TITLE OF CERTIFIER 755. N/A <br /> 762. <br /> President of Wendt Construction if certifier is other than CUPA/LIA check appropriate box below-. <br /> 736. <br /> AAARBSS . ❑ a. Certified Industrial Hygienist(C)I) <br /> P.O.Box 1403 ❑ b. Certified Safoty Professional(CSP) " <br /> CITY 757, L3 c. Certified Marine Chemist(CMC) <br /> Lodi,Ca 95241 — [:1 d. Registered Environmental health Specialist(REAS) <br /> PHONE <br /> 7s9. ❑ e. Professional Engineer(PE) <br /> 209-547-9310 ❑ f. Class II Registered Environmental Assessor <br /> DATE759" CRRTIFICATION TiJvIE ® S. Contrtictors'State License Board licensed contractor(with hazardous <br /> substance removal certification) <br /> January 7,2014 11:00 AM <br /> 763. <br /> TANK PREVIOUSLY HELD F"WAABLE OR COMBUSTIBLE MATERIALS <br /> gryak tM tadt ieterlor amwrphs(s shell be mchscked with a oorttbustibla ere indieatvr pr+ct tow k being conducted on the tank.) ❑ Yes ❑ NO <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER.DISPOSAL PACILITX,FTC: 764. <br /> —Tank,bas_=n-r,ltanaLhy_AdamS,Q&rYxqo.5-Ansi.slP� meet Title 22 zequiremezats. Crusb w/Heavy_ <br /> Equipment. <br /> A copy oftbis certificate stint accompany the tank to the recychustdisposal tkcility and be provided to the agency overaeeiag talc closure(i.e.CUPA or otbcr authorized local agency); the <br /> owner andlor operator of the tank system;and the tenk removAl ooattactor. <br /> UPCF HWF1249(1/99)-1/2 www.unidocs.org Rev.02/16/00 <br />