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-330 <br /> 1. (a) Is the current certificate of worker's compensation insurance on file? YES 9 NO[] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YESY,NO[] <br /> (c) Has everyone onsite, including crane/backhoe operator, been certified to work on ,.,,.,,tt <br /> hazardous waste sites in accordance with CCR Title 8? YES],ry NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES yl\\ NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A YES[] NO[] If YES, Permit# _ <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAKYES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes, please explain)YES[] NO 111 <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: T'I v< <br /> Name / /G'4it7 'Iyl,%eee f/2;,� Hauler Registration# <br /> Address on <br /> -0 13,0 -G/ City Zip S.3 /� <br /> Phonefl <br /> f <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YEY NO[] <br /> b. Identify contractor performing decontamination: /\ <br /> Name �//✓/ /��/S/bg? ^ <br /> Address /P7 t.//,o X �z 5 7 City zip 1; <br /> Phone No. Z-6 :�:34 efL 61 ;750 <br /> C. D,5scribe method to be used for decontamination: 20/e-/. ,2/n/S, - rH C/0 - <br /> �,zA,) <br /> d. D scribe how rinsate material will be stored onsite pri rto manifesting offsite: <br /> /�,ASA7e 70 ,3 s7a:tet,� /.J /?epi-Ao. f•) /V4Z-/nATD,r✓07s <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name l7��/£SCI`/C�ii1��/� C Hauler Registration W _L3.� � <br /> Address ice© rJ�R 7-Q City /�� /T Zip <br /> Phone No. IM -33-2- <br /> Permitted <br /> 3-2-Permitted Disposal Site -� � 2/ )e6W <br /> 8. a. Desc' e the method that will be utilized to ur a and/or inert the tank(s): <br /> rt -OQO <br /> b. Tank/Piping Hauler: <br /> Namey /.1yf //S/r�/Z&E 10/l <br /> Address /'d'130 3�i 7 City zip <br /> Phone No.( ? D c/ ) _�j -�4-e C <br /> e7 � LSz3 V-s} <br /> Hauler Registration#(if hauled as hazardous) 251/�� C/rC G zt g, (�S If-/ <br /> j> /CC q2t� (=,,1(///toJ�tC✓79C SEa�vic�S <br /> 00507- 5-75 13y/z0,J Gq. <br />