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06/02/2005 10:26 FAX 510 614 F-1 PARADISO MECHANICAL (1017 <br /> UNIFIED PROGRAM CONSOLIDATED FORINT <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> page 2 of 7 <br /> 1.FACILITY IDENTIFICATION <br /> 1. <br /> BUSINESS NAME(swue m FACILITY NAML•or DBA—Doing Business As) 9• FACILITY rD# <br /> sBELL- SAP lyjJ.4C) 77CO i-RELAJ(il, c'aLill; 1� y CA 95212 <br /> 740. <br /> TANK OWNER NAME <br /> SHELL OIL PRODUCTS US <br /> 741, <br /> TANK OWNER ADDRESS <br /> 12700 NORTHBOROUGH DRIVE <br /> TANK OWNER CITY HOUSTON 742 1 STATE TX 743. ZIP CODE 77067-2502 744. <br /> II.TANK CLOSURE INFORMATION <br /> 11ipk m* Concentration of Flammable Vapor Concentration of Oxygen <br /> (Anach additional copies <br /> of mi:' for more than Top Center Bottom Top Center Bottam <br /> TANK d rcc tank;) <br /> INTERIOR 1 745. 74611. 746b 146c, 7471 747b. 747c. <br /> ATMOSPHERE 75ob. 75ob, <br /> READINGS 2 749. 7490. 749b. 749c. 750"- <br /> 3 751, 732L 752b, 752c. 75311- 753h 753h <br /> III.CERTIFICATION <br /> On examination of the tank,1 certify the tank is visually free from product,sludge,scale(thin,flaky residual of tank contents).rin7???and debris.I further ccgi- <br /> fy that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATU"OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> �f 160.Certifier is a mpresental/vc of Elie CUPA,authorized agency,or LIA: <br /> 754, p Yes X No <br /> NAME OF CE>{TIFIER(Print) <br /> Name761. <br /> Nac of CUPA,authorized agency,or L[A: <br /> TITLE OF CE MF1ER 755. NIA <br /> PAPIE4:1:117 X51' If certifier is other than CUPA/LIA check appropriate box below; 762 <br /> ADDRESS 756. ❑ a- Certified Industrial Hygienist(CIH) <br /> D1,(,1T OF :20tl'l `T� ❑ h Ccrtificd Safety Professional(CSP) <br /> C[rY 757. ❑I c. Certified Marine Chcmist(CMC) <br /> 'JLVOX ❑ d- Registered Lnviroo=ntal Health Specialist(REAS) <br /> PHgNE 759- ❑ c. Professional Engineer(PE) <br /> 5 M( ;`�iorJuIS ❑ f. Class 11 Registered Environmental Assessor <br /> DATE 759, CERTIFICATION TIME ❑ g. Contractors'State License Board licensed contractor(with <br /> hazardous substance removal certification. <br /> 763- <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS <br /> (If yes,rix ng interior atmosphere:hall be rx�heet.'ed with a combustible gas Indicator prior to work being completed on the tank.) YCs ❑ No <br /> rung <br /> 764, <br /> CERTTFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC. <br /> VASJ 1,,(AD l��i I IL TANKS/PIPING MEETS TITLE 22 REQUIREMENTS <br /> =i(.m (d, VA—M) R�h) CRUSH WITH HEAVY EQUIPMENT <br /> A copy of this certificate shall accompany the tank to Elle recycling/disposal facility and be provided to the agency overseeing tank closure(i.e,CUPA or other <br /> authorized local agency);the owner and/or operator of the tank system;and the tank removal contractor. <br />