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1. (a) Is the current certificate of worker's compensation insurance on file? YESBNO[] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YES ✓ NO[] <br /> (c) Has everyone on site, including crane/backhoe operator, been certified to work on <br /> hazardous waste sites in accordance with CCR Title 8? YES[,—V]' NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES VNO[] <br /> 3. Has,applicant performing removal in the City of Tracy obtained a"Grading and cavation Permit"? <br /> N/AI_/] YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perfo tank cutting?NA[]YESUNO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping (If yes, please explain)YES[] NO� <br /> No <br /> 6. If tank residual exists, tify transporting hazardous waste hauler: <br /> Name unknown-P.ntlm9 lyses Hauler Registration# <br /> Address City Oakland Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decont inated pri to removal? YESONO [] <br /> b. Identify contractor performing decon mina on: <br /> Name All Chemical Disposal <br /> Address 21Gmat0.k.6Nd City San dgse Zip 95119 <br /> Phone No.(405 1499-5274 <br /> C. Describe method to be used f decontamination. <br /> Clean in erior tank with Simple Green and ter Solution. Muck out tank of a solids or fuel prior to defining. <br /> d. Describe how rinsate aterial will be stored onsite prior to manifesting offsite: <br /> The rinsate marginal will be aro within 55 Ballon DDT rated Drums. <br /> e. Rinsate Haule and permitted Treatment,Storage& Clap o I Facility: <br /> Hauler Na Unknown-PendingAns"es Hauler Registration# <br /> Address City Zip <br /> Phon o. ( 1 <br /> Per itted Disposal Site <br /> 8. a. Describe the method that will,be utilized to purge and/or inertthe to nk(s): <br /> All Chem will heave any UST piping and related elulpment neceuary b gain ecceee to Me Interior of Me UST. Nl Chamwlll Nen lnad th ST wllM1 orgenlc vapor auprasseanl enE dr,ice. <br /> AR Chem will remove any Mahn.and hort.minated solids cunentry,filling Ne UST,Wth paellc shovel.. <br /> b. Tank/Piping Hauler: <br /> Name Not Apprlpme <br /> Address City Zip <br /> Phone No.( ) <br /> Hauler Registration#(if hauled as hazardous) <br /> EH 23 046 (Revised 8/1/11) 4 <br />