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UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS WASTE HAZARDOUS WASTE TANK CLOSURE CERTIFICATION Pae of I. FACILITY IDENTIFICATION BUSINESS NAME(Same as FACILITY NAME or DBA—Doing Business As) 3 FACILITY ID# 1 Pick-n-Pull Auto Dismantlers Stockton LLC CERS ID: 10183144 TANK OWNER NAME 740 Pick-n-Pull Auto Dismantlers Stockton LLC TANK OWNER ADDRESS Tal 3027 Clark Drive TANK OWNER CITY Stockton 742 STATE CA 743 ZIP CODE 95215 744 II. TANK CLOSURE INFORMATION Tank ID# Concentration of Flammable Vapor Concentration of Oxygen (Attach additional copies of this page for more than TO Center Bottom To Center Bottom TANK three tanks) P P INTERIOR1 745 746a 746b 746c 747a 747b 747c ATMOSPHERE Not Applicable: The tank was used for the CalRecycle Used Oil Collection Program. No READINGS 2 flammable materials were placed in the tank. All used oil was removed from the poly sob 750c 3 tank and the tank disposed of as a Non-RCRA hazardous waste. sib 753c III. CERTIFICATION 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 the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON Certifier is a representative of the CUPA,authorized agency,or LIA: 760 NAME OF CERTIFIER (Print) 754 ❑ Yes ❑ No Name of CUPA,authorized agency,or LIA: 761 TITLE OF CERTIFIER 755 If certifier is other than CUPA/LIA check appropriate box below: 762 ADDRESS 756 El a. Certified Industrial Hygienist(CIH) ❑ b. Certified Safety Professional(CSP) CITY 757 El c. Certified Marine Chemist(CMC) ❑ d. Registered Environmental Health Specialist(REHS) PHONE 758 E] e. Professional Engineer(PE) ❑ f. Class II Registered Environmental Assessor 759 ❑ g. Contractors'State License Board licensed contractor(with hazardous DATE CERTIFICATION TIME substance removal certification) TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS 763 (If yes,the tank interior atmosphere shall be re-checked with a combustible gas indicator prior to work being conducted on the tank.) (motor oil only) ® Yes ❑ NO CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER,DISPOSAL FACILITY,ETC: 764 Not Applicable:All used oil was removed from the poly tank and the tank disposed of as a Non-RCRA hazardous waste. The tank was not recycled/scrapped. A copy of 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 agency; wrier/operator of the tanksystem;removal contractor;and the recycling/disposal facility. UPCF(12/99) 39 Formerly DTSC 1249(6/98)