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I• (a) Is there a PyS_ , <br /> Hs On file or <br /> onnaire <br /> (b) Is the current certificatetOf worker'seco1mpensation insurancelOnefile? <br /> (c) Does the contractor possess a "HazaYES [� NO <br /> nlous Substance [ [ <br /> (d) Has everyone on site, including crane/backhoe operator, been certified <br /> hoo"+ YES ( [ NO kr work on hazardous waste site in accordance with CCR Title 8? YES NO I I <br /> '-• Has a <br /> "Site Health & Safety Plan" for thisYES pr- NO [ <br /> job site been submitted? / <br /> 3• Has applicant performing removal in the YES I NO ( <br /> N/A Al YES I I NO ( I City of Tracy obtained a " <br /> U If YES, Permit # Grading and Excavation Permit"? <br /> 4• Has the contractor obtained approval from the local fire department to perform tank cutting? <br /> 5• Is there knowledge or evidence of leakage from the tank(s) and/or i in , NAI I YES[ I NO[ <br /> P P g. (If yes, please explain) YES ( I NO I <br /> 6• If tank residual exists, identify transporting hazardous waste hauler: <br /> Name <br /> Hauler Registration # <br /> Address <br /> City <br /> Phone # � --� Z'P----- <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? <br /> YES NO f I <br /> b. Identify contractor performing decontamination: <br /> Name I,Ls,� �I <br /> Address 17, I �Z S j <br /> city a zip 9(-7�� <br /> Phone No.( 104, ) to LZ_ 3 t( 2 N <br /> C. Describe method to be used for decontamination: <br /> 't�0_.ol N 6,a;�4� , 4-9 -rA IL• rt'l� +kk � <br /> w tt <br /> ,T�_-.n � <br /> d. Describe how rinsate material will be stored onsite priof to manifesting offsite: <br /> % Vp<<,,., , p <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name <br /> Hauler Registration # <br /> Address City <br /> Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> .0 <br /> Elf 23 046 (Revised 4/I I/96) <br />