Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Pae I of I <br /> I. FACILITY IDENTIFICATION <br /> BUSINESSNAME (Same asFACB.rrYNAWorDBA — Doing Business As) 3, FACILITY ID# 1 ' <br /> Premier Finishing <br /> 740. <br /> TANK OWNER NAME <br /> Premier Finishing <br /> 741 . <br /> TANK OWNER ADDRESS <br /> 7910 Longe Street <br /> TANK OWNER CITY Stockton 742' STATE CA 743 ZIP CODE 95206 744. <br /> IL TANK CLOSURE INFORMATION <br /> Tank ID # Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> of this page for more than Top Center Bottom Top Center Bottom <br /> TANK three tanks) <br /> INTERIOR1 745. 746a. 7466, 746c. 747a, 747b. 747c. <br /> ATMOSPHERE <br /> READINGS 2 748. 749a, 749b. 749c. 750a. 750b, <br /> 750c. <br /> 751. 752a. 752b, 752c. 753a. 753b. 753c. <br /> 3 <br /> M. CERTIFICATION <br /> On examination of the tank, I certify the tank is visually free from product, sludge, scale (thin, flaky residual of tank contents), riuseate and debris. I further certify that <br /> the information provided herein is true and acclraie to the best of my knowledge. <br /> SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> 760, <br /> ��� Certifier is a representative of the CUPA, authorized agency, or LIA: <br /> 754' ® <br /> NAME OF CER FIER (Print) El Yes No <br /> 761, <br /> Gary Reeves Name of CUPA, authorized agency, or LIA: <br /> . <br /> TITLE OF CERTIFIER 755N/A <br /> 762, <br /> CEO If certifier is other than CUPA / LIA check appropriate box below: <br /> ADDRESS 756. ❑ a. Certified Industrial Hygienist (CIH) <br /> 4649 Monarch Court ® b. Certified Safety Professional (CSP) <br /> CITY 757* El c. Certified Marine Chemist (CMC) <br /> Turlock ❑ d. Registered Environmental Health Specialist (REHS) <br /> 758. <br /> PHONE ❑ e. Professional Engineer (PE) <br /> 209 661 6611 ® f. Class If Registered Environmental Assessor <br /> 759. ❑ g. Contractors' State License Board licensed contractor (with hazardous <br /> DATE CERTIFICATION TIME substance removal certification) <br /> 4/21 /2019 9 : 30 AM <br /> 763 . <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS <br /> (If yes, the tank interior atmosphere shall be re-checked with a combustible gas indicator prior toworkbeingconducted onthe tank) ❑ Yes ® No <br /> CERTIFIEWS TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY, ETC: 7644 <br /> No air readings were taken. Tank was repurposed into an aqueous rinsate tank. No tank testing was performed as the tank is an open <br /> top tank and three of the five surface areas are not accessible (two sides & the bottom) .Previous contents was hexavalent chromium . <br /> A copy of this certificate shall accompany the tank to the recyclingfdisposal facility and be provided to the agency overseeing tank closure (i.e. CUPA or other authorized local agency); the <br /> owner and/or operator of the tank system; and the tank removal contractor. <br /> UPCF RWF1249 (1/99) - 1/2 wsysv.unidocs. org Rev. 02/ 16/00 <br />