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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> F77 HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Pae of <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# i 10 1 11 8 3 5 6 9 1 1 <br /> Thatcher Chemicals <br /> Tao <br /> TANK OWNER NAME <br /> Thatcher Company of California-Stockton <br /> TANK OWNER ADDRESS 741 <br /> 1010 Industrial Drive <br /> TANK OWNER CITY Stockton 742 1 <br /> STATE CA 743 ZIP CODE 95206 744 <br /> H. TANK CLOSURE INFORMATION <br /> Tank ID# Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> of this page for more than <br /> TANK three tanks) Top Center Bottom Top Center Bottom <br /> ' <br /> INTERIOR 745 746a 7460 746, 747. 7476 747. <br /> ATM [ETank OSPHERE ank A <br /> READINGS 2 Tank B 748 749a 7496 749c 750a 750b 750c <br /> 751 752a 752b 752c 753. 753b 753c <br /> 3 Tank C <br /> III. CERTIFICATION <br /> On examination of the tank,I certify the tanki 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 ac to to the best of my knowledge. <br /> SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> ZI / Certifier is a representative of the CUPA,authorized agency,or LIA: 750 <br /> 754 <br /> � NA OF CER F M ❑ Yes No <br /> James Ka MPH,CIH,CSP, CIH 8877 CP Name of CUPA,authorized agency, 751 <br /> pin, ( ) g cy,or LIA: <br /> TITLE OF CERTIFIER 755 <br /> Manager for EM Services,ACTEnviro if certifier is other than CUPA/LIA check appropriate box below: 762 <br /> ADDRESS 756 <br /> V/ a. Certified Industrial Hygienist(CIH) <br /> 2010 West Mission Road <br /> ❑ b. Certified Safety Professional(CSP) <br /> CITY 757 <br /> ❑ c. Certified Marine Chemist(CMC) <br /> Escondido ❑ d. Registered Environmental Health Specialist(RENS) <br /> PHONE 758 ❑ e. Professional Engineer(PE) <br /> 760-489-5600 <br /> ❑ f. Class II Registered Environmental Assessor <br /> DATE 759 CERTIFICATION TIME ❑ g. Contractors'State License Board licensed contractor(with hazardous <br /> substance removal certification) <br /> 12-24-2020 <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763 <br /> (If yes,the tank interior a-phorc shall be re-checked with a combustible gas indicator prior to work being conducted on the tank.) ❑ Yes %,/ No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 754 <br /> Three of the four tanks held corrosive liquids:B-Sodium Hydroxide,C-Hydrochloric Acid &D-Sodium Hypochlorite <br /> Tanks were cleaned and flushed and then cut into pieces,as described on attached 12/15/20 memo.Surface pH of debris was measured-all surface pH was <br /> between 7-8 <br /> Rinsate was collected and evaluated prior to disposal.See attached memo for additional information <br /> A copy of this certificate shall accompany the tank to the recycling/disposal facility and be provided to the CUPA. If there is no CLIA,copies shall be submitted to the LIA and authorized <br /> agency;owner/operator of the tanks stem;removal contractor-and the recycling/disposal facility. <br /> UPCF(12/99) 39 Forinerly DTSC 1249(6/98) <br />