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CM <br />M <br />(b) Is the current certificate of worker's compensation insurance on file? YES )+4 NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES )4 NO [I <br />(d) Has everyone on site, including crane/backhoe operator, been certified to work on <br />(e) hazardous waste site in accordance with CCR Title 8? YES ]ig NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ ] NO pQ <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A X YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAA YES[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NOM <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name Americom Uc.l(ey W4 --Ne Oil Hauler Registration# <br />Address I•O. Box 340 City De <br />Phone # <br />Decontamination Procedures: <br />Z - 11(ol15 <br />9531& <br />a. Will tank(s) and piping be decontaminated prior to removal? YES 64 NO ( ] <br />b. Identify contractor performing decontamination: <br />Name_A�Van ced Geo i.(\vCron men�a� <br />Address Y) Rb City S -oy-+ov Zip g5x-5- <br />Phone No.( e7-0`1 ) Li (.0 ) 00(0 <br />C. Describe method to be used for decontamination: <br />Trlple ?-;nse :- %,; q,, �Mssurc woiln <br />d. Describe hei rips to material will be stored onsite prior to manifesting offsite: <br />�rr.Qed ;reL+ly �rO, VS-' <br />C. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name �tA fner i r cen Vo- V (. OL i Hauler Registration # <br />Address AS Above City Zip <br />Phone No. ( $00 ) 731 - 9(d415 - <br />Permitted Disposal Site ():1 Tcp.Y�sCrer <br />EH 23 046 (Revised 10/16/03) Page 4 <br />