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UNIFIED PROGRAM CONSOLIDATED FORM <br /> IIA.ZARDOUS 'WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Page "I of 2 <br /> L :_FACILITY IDENTIFICATION <br /> BUSINESS NAME (samessFAcmTrYNAMEorDBA -DoingBusinessAs) 3• FACILITY ID# F I A 0 0 0 'r 3 6 1131 1 l ' <br /> ARCO am/pm Fuel Facility FAC 47049 <br /> TANK OWNER NAME <br /> 740. <br /> BP West Coast Products , LLC <br /> TANK OWNER ADDRESS 741 . <br /> PO Box 6038 <br /> TANK OWNER CITY Artesia 742' STATE CA 743' ZIP CODE 90702 744, <br /> II. .TANK CLOSURE INFORMATION <br /> TankID # ConcenhationafFlammable Vapor Concentration of Oxygen <br /> (Attahadditional rnpies <br /> TANK oftlaspagfnt ) roan Top Center Bottom Top Center Bottom <br /> ATMOSPHERE PIIERE I 70339507 uu D 746x. 7466. 746o. 747a 747b. 747c. <br /> 0 % 2b. 20 . 9 % 20 . 4 % <br /> READINGS 2 10339507'& 749°• 749h. 749o. A 750x 7506, 750o. <br /> o Z. I . 3 .b 21 . 3 pa Z-t . 5 y <br /> 3 lD33950726b7Ma• 7526• 7520. 7533. 753b. 753% <br /> ©�a � � o z1 .3gJ 21 . 3 <br /> HL CERTIFICATION <br /> On examination of the tank, Ixtatifytbetankis visualigfinefmniproduct, sludge, scale (thin, flaky residual of tank contents), rinseate and debris, I further certify that <br /> the information provided irerzmis tnreandaccuratoto f►e best ofmy knowledge. <br /> SIGNATURE OF CSR STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Certifier is a representative of the CUPA, authorized agency, or LIA: 760. <br /> NAME OF CERTIFIER (Pring 754. ❑ Yes ® No <br /> Paul Freeman Name of CUPA, authorized agency, or LIA: 76t. <br /> TITLE OF CERTIFIER 755' N/A <br /> Technician ifcertitierisotherthan CUPA / LIA check aPP P appropriate box below: 762, <br /> ADDRESS 756. ❑ a. Certified Industrial Hygienist (CIH) <br /> 25971 Towne CentreDr'ive <br /> ❑ b. Certified Safety Professional (CSP) <br /> CITY 7ST ❑ c. Certified Marine Chemist (CMC) <br /> Foothill Ranch , DA '92610 ❑ d. Registered Environmental Health Specialist (REHS) <br /> PHONE 7598 ❑ e. Professional Engineer (PE) <br /> 949460-5200 <br /> ❑ f. Class II Registered Environmental Assessor <br /> 759. [9 g. Contractors' State License Board licensed contractor (with hazardous <br /> DATE CERTIFICATION TIME substance removal certification) <br /> -� t 15' 1 a1 ia :2sA�1 <br /> 763. <br /> TANK PREVIOUSLY;HELD FLAMMABLE OR COMBUSIIEL ES MATERIALS <br /> (ifycs, thetankinterioratmosphereshallbore-eheckedwidta=nAaiTdbleuuindicNarprlvrtovwkl)emgconductcdonthetnnk) {J Yes ❑ No <br /> CERTIFIER' STANKMANAGEMENTINSTIIUCTIONSFOESCRAPDEALER DISPOSAL FACILITY, ETC: 7646 <br /> Tanks have been certified as clean , dry and inert. Please dispose at lanfill as non-hazardous . <br /> A copy or this certificate shall accompany the tank to the recycling/disposal 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 HWF1249 (1/99)-112 wivw.unidoes.org Rev. 02/16/00 <br />