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(b) L the cw ,ent certificate of worker's compensation insurance on.file? YL•S NO[] <br /> (c) Docs fl'te con',actor possess a."Hazardous Substance Removal Certification"? fl S� NO [ <br /> (d} Has everyone on site,including crane/backhoe operator,been certified to work or. <br /> (ei hazardous waste site in accordance with CCR Title 8? YF-5)( NO [I <br /> 2 Has a",Site Health&-Safety)?IW for flus job site been submitted? y (I NO <br /> 3. Has applicant performatg removal in the City of Tracy obtained a"Grading and bxeava'clon Kermit"? <br /> NIA° ' -�Y [] NO[] If YES, Permit# _ <br /> 4. Has t�hr corftctor obtained approval from the local fire department to perform tarik cutting?NA[]YES')NO ] <br /> S. Is there laowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please exylav;?''fiS[] NO <br /> 6. if tank�—gdua;exists,identify transporting hazardous r. <br /> �waste haule <br /> Name�,( <br /> �t i i h�O Z �M 4'-Olkpw JA t Hauler Registration# <br /> address LCqA EKRh1 l- r1IS cty b'P�+-�M Zip <br /> Aecort4amv-tation Procedures: <br /> ?. Will tank(s)and piping be decontaminated prior to removal? kES NO[J. <br /> b. Identify contractor performing decontamination: <br /> UQ,Name !'Y�p Mi`1 t�I"t(.�[' � UQ, <br /> Addres31 l "! 5(�(��A � cih Iun� _Zip <br /> Describe method to be used for decontamination: <br /> d. Descr;Ba how rinsats material will be stored onsite prior to manifesting o:Ysice; <br /> �. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: " ~� <br /> Hauler Name © I l"}D�ZrD ArF�17t�1� Hauler kLegisti'afion# <br /> Address t1. Jt3C [� /1IV1f1i ©�KAS7 zip <br /> Phare No_ a o R zz- q 8`t <br /> Permitted Di.spoaalsite C'm5b t 1„©yeicw, loo 1-7`1 a"agU)o:,..` ' <br /> EH 23 09 (Feviwdl0/3.6103) Page 4 <br />