Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS WASTE <br /> HAZARDOUS WASTE TANK CLOSURE CERTIFICATION <br /> Pae 2 of 2 <br /> I. -.FACILITY IDENTIFICATION <br /> BUSINESS NANO (Same nsFACILITYNAMEorDBA — DoingBusinessAs) 3. FACILITY ID# F A 0 0 0 3 6 3 3 1 t <br /> ARCO am/pm Fuel Facility FAC #7049 <br /> 740. <br /> TANK O WNER NAME <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 /> Tank ID # Concentration of Flammable Vapor Concentration of Oxygen <br /> (Attach additional copies <br /> ofddspagcformoretban Top Center Bottom Top Center Bottom <br /> TANK three tanks) <br /> INTERIOR1 745. 746L 746b. 746c. 747x. 7476. 7470. '... <br /> ATMOSPHERE <br /> READINGS 748. 749x. 4 749b. 8 749c. 750a. ` • 750b. 7500. <br /> 2 <br /> 10339507-00 7a Zl 3 9d Z 3 1e 21113 Xo <br /> 3 751 . 752x. 752b. 7520. 753x, 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 and accurate to the best of my knowledge. <br /> SIGNATURE OF CERTIFIER STATUS OR AFFILIATION OF CERTIFYING PERSON <br /> Certifier is a representative of the CUPA, authorized agency, or LIA: 760' <br /> NAME OF CERTIFIER (Print) 754. ❑ Yes ® No <br /> 761. <br /> Paul Freeman Name of CUPA, authorized agency, or LIA: <br /> TITLE OF CERTIFIER 755. N/A. <br /> Techniean If certifier is other than CUPA / LIA check appropriate box below: 762. <br /> ADDRESS 756' ❑ a. Certified Industrial Hygienist (CIH) <br /> 25971 Towne Centre Drive <br /> ❑ b. Certified Safely Professional (CSP) <br /> CITY 757' ❑ c. Certified Marine Chemist (CMC) <br /> Foothill Ranch , CA 92610 ❑ d. Registered Environmental Health Specialist (REHS) <br /> PHONE 758' ❑ e. Professional Bngineer (PE) <br /> 949-460-5200 <br /> ❑ f. Class II Registered Environmental Assessor <br /> DATE 759. CERTIFICATION TIME l� g• Contractors' State License Board licensed contractor (with hazardous <br /> substance removal certification) <br /> -I ! r $ I lq lL : aSA #& <br /> 763. <br /> TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS <br /> (Ifyoc, the tank interior mmosphom shall be ro-checked with a combustible gas indicator prior to work being conducted on the tank.) Xl Yet ❑ No '... <br /> CERTIFIER' S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY, ETC: 764• <br /> Tanks have been certified as clean , dry and inert. Please dispose at lanfill as non-hazardous . <br /> A copy of this certificate shall accompany the tank to the recyclingldisposal 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 /> 000 <br /> UPCF HWF1249 (1/99) - 112 www.unidocs.org Rev. 02/16/00 <br />