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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Pa c of <br /> I. FACILITY IDENTIFICATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA–Doing Business As) 3 i FACILITY ID# 1 Q 1 g 3 5 6 9 1 1 1 <br /> Thatcher Chemicals <br /> i TANK OWNER NAME <br /> 740 <br /> Thatcher Company of California-Stockton <br /> TANK OWNER ADDRESS <br /> 741 <br /> 1010 Industrial Drive <br /> TANK OWNER CITY Stockton lag 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 /> ofth;s three tanks)f ks)R than <br /> TANK tthTop Center Bottom Top Center Bottom <br /> INTERIOR 1 Tatlk D 745 745a 7460 746c 747a I 7476 747c <br /> ATMOSPHERE <br /> READINGS 2 748 749a 749b 749c 750. 7506 750c <br /> 3 751 752a 7526 752c 753a 753b 753c <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),rinseate and debris. I further certify that <br /> the information provided herein is true rd accurate to the best of my knowledge. <br /> SIGNACE <br /> EI;TIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Certifier is a representative of the CUPA,authorized agency,or LIA: 750 <br /> NAMIER (Print) 754 ❑ Yes ✓ No <br /> James Kapin,MPH,CTH,CSP(CIH8877 CP) Name of CUPA,authorized agency,or LIA: 751 <br /> TITLE OF CERTIFIER 755 <br /> Manger of EM Services,ACTEnviro If certifier is other than CUPA/LIA check appropriate box below: 752 <br /> ADDRESS 756 <br /> a. Certified Industrial Hygienist(CIH) <br /> 2010 West Mission Street ❑ b. Certified Safety Professional(CSP) <br /> CITY 757 El c, Certified Marine Chemist(CMC) <br /> Escondido <br /> ❑ d. Registered Environmental Health Specialist(REHS) <br /> PHONE 758 <br /> ❑ e. Professional Engineer(PE) <br /> 760489-5600 ( ❑ f. Class II Registered Environmental Assessor <br /> 759 ❑ g. Contractors'State License Board licensed contractor(with hazardous <br /> DATE CERTIFICATION TIME substance removal certification) <br /> 12/24/2020 <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 753 <br /> of ycs,the tank imcrior atmosphcm shall be re-checked with a wmbustiblc gas indicator prior to work being Gond—d on the tank.) ❑ Yes V" No <br /> CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 764 <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 <br /> was between 7-8 <br /> Rinsate was collected and evaluated prior to disposal.See attached memo for additional information <br /> � A copy ,this certificate shall accompany the tank to the recycling/disposal facility and be provided to the CUPA If there is no CUPA,copies shall be submitted to the LIA and authorized <br /> agency;owner/operator of the tank system;removal contractor and the recycling/disposal facility. <br /> UPCF(12/99) 39 Formerly DTSC 1249(6/98) <br />