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1. (a) Is the current certificate tworker's compensation insurance on file? • YES WINO [] <br /> (b) Does the contractor possess a "Hazardous Substance Removal Certification"? YES V/ 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? Y V/ NO[] <br /> 2. Has a"Site Health &Safety Plan"for this job site been submitted? YES 7NO [] <br /> 3. Has,applicant performing removal in the City of Tracy obtained a "Grading and Excavation P rmit"? <br /> N/AI_/l YES[] NO (I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tan/ase <br /> NA[]YES(dNO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes, plain)YES [] NO� <br /> No <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name All Chem Disposal /.n <br /> ler Registration#2914 <br /> Address 21 Great Oaks Zip 95119 <br /> Phone#(408-499-5274 ). <br /> 7. Decontamination Procedures: <br /> a. Will lank(s)and piping be decontaminated /toemoval? YES�NOb. Identify contractor performing decontamina <br /> Name All Chemical Disposal <br /> 21 Great Oaks Blvd San Jose 95119 F <br /> Address City Zip �V�s <br /> Phone No.(aos )499-5274 <br /> C. Describe method to be used for contamination: <br /> Clean interior lank with Simple Greer and Water olution. Muck out dank of any solids or fuel prior to cleaning. } <br /> 5 <br /> d. Describe how rinsate mat ial will be stored onsite prior to manifesting offsite: <br /> The rinsate material will be stored within 55 gallon DOT rated Drums. <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name All em Disposal Hauler Registration#2914 <br /> Address 21 Gr t Oaks City San Jose Zip 95119 <br /> Phone N . (4oe )499-5274 <br /> Per*ed Disposal Site Filter Oil Recycling,San Jose,California <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> All Chem'will remove any UST piping and rslalad equipment necessary to.gain access to the inleainr of the UST. All Chem will then inert the UST with organic vapor sup—mant and 30 lbs of dry ice. <br /> All Chem will remove any debris and contaminated solids currently filling the UST,with plastic shovels.. <br /> b. ank/Piping Hauler: <br /> Name Not Applicable <br /> Address City Zip <br /> Phone No.( ) <br /> i Hauler Registration#(if hauled as hazardous) <br /> Eli 23 046 (Revised 8/1/11) 4 <br />