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1 (a) Is there a F53111D oontraotor's and subecnt m=r'a gnestinnnalro on file or enc2osedt YSS 2I0[) <br /> (b) 13 the current certi2eate of workar's compensatka insarance en Ole" YES N No 1 j <br /> 1r,) Does the contraetor possess a 13azartlnes Substance Removal CzM1fleaticn"7 YES A <br /> (d) Has 170r,70 a un site.LIClndinS cranetSdAliee operatc=,been ce ad <br /> to work on haaardons waste site In accordance with CCS 71tie 44 YES M NO i 1 <br /> 2 Has a `Site Health&3arety Ran" for this lob site bee=submi-Aed? YES N1 ND 1] <br /> 7. Has appH:ant performing retnoval ht the Qty of Tracy obtained a"Gradin@ and Excavation Permit"' <br /> VAid YES f 1 NOL It YES, Permit E <br /> 4. Ras the contractor obmtnad approval bora the local fire department to perform tank cutttW, NA(-XYES[)N011 ^ <br /> a, is there lmawledge or eAdenre of ltakage from the tan.'f4s)a=d'a piplug? (11 yes,please explain)YDS() 270[1c <br /> g, If tank residual exists.idemOV tt'anapordag hazardous masts hauler. <br /> Name NORCAL Waste Oil Haulers `HauleriiegMratim0 CAD 982417255 <br /> Address P.O. Box 645 Lttq Denair, CA Mp 95316 <br /> phone f( 800 _i 322-8710 <br /> DecnntamUtation Proeedares: <br /> a. Will ra*s)and piping be decontaminated prior to removal' YES 1k '1011 <br /> b. Cdentplcontractor performing decoumloine= <br /> Name Jim Thorpe Oil , Inc . <br /> Address <br /> P.O. Box 357 City Lodi , CA np 95241-0357 <br /> Phone No' 2t 09 ) 368-6175 <br /> c. Describe method to be used for decontamination: <br /> T''7 KI C Ul I I h t 1 P7 P l CPfI p <br /> manner . <br /> �. Describe hmv rinsate material will be Stored onsite prior to msniresting offstte: <br /> Rinseate will either be remove om frhe t nk( s) and linhisas <br /> thev are being ri sed the r <br /> truck, or be stored in sealed drums until it can be disposed of, <br /> e, E ins.Se Haclet and perntlud Treauaent.Stcraqea <br /> HaplerNama Same as #6 Haule!Regisa-zaan# <br /> Add:ess city Zip <br /> PboneNo.! i <br /> Permitted0isposalSite Americlean , Inc . 2570 Almond Dr. , Silver Springs > <br /> NV. or other approved facility. <br /> EN 22 048 (Revised MIMS) Page 4 <br />