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t. (a) Is the current certificate of worker's compensation insurance on file? YESf< NO[] <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 NO(I <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES NO[] <br /> 3. Has apylicant performing removal in the City of Tracy obtained a"Gradin and Excavation Permit"? <br /> N/A; YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YESKNO[] <br /> 5. Is there knowledge or evidence of leakage from the tanks)and/or pipingZ If yes,please explain) ES L] NP� <br /> glair/ </ST f st/✓f_Jn<�!-/?9N .oel4 Z� <br /> 6. If tank residual exists,identify transpo azardouwaste hauler: <br /> Name l/GS Hauler Registration# <br /> Address �O, ,Q6SC „�9 city a,00/cs zip 95628 <br /> Phone#( 9Y6 ) 99a'-G333 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated pdorto removal? YES)< NO[] <br /> b. Identify contractor performing decontamination: <br /> Name er/Ca�L/ C4�f11✓!i/'/.Lt/T1 <br /> Address 2/Gd/G04,a �/�li�iJ� LLi cf'�Ity G zip 9-5-7fYy <br /> Phone No.( 6 ) �oz <br /> C. Describe method to be used for decontamination: <br /> f�ia✓f sb!' '73�<G Gc�v tet/%1 7'0 <br /> w i Gr?/HA26� �[tr/1yrs Ail rn rJf✓�— <br /> d. Describe howppnsate material will be stored onsite prior to manifesting offsite: <br /> 7=C/fsGGw/ da.= l <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name 14-yGS Hauler Registration# A"491- <br /> Address oe s� y 9 City /241v— Zip <br /> Phone No.( <br /> Permitted Disposal Site��/�GaLri(iy lf.1f7L0/#•[ �o.4/J �f.T GygLLrlFZGG <br /> 8. a. Describe the method that will be utilized to purge and/or inert th9 tank(s <br /> RECE1VjgVWg Hauler: <br /> Name <br /> NOV 2 0 2014 ���GG,�/ Gew/✓vc� I�/'� �7%/� <br /> Address„ /�O C'm�'o ��j�LGf 5' City/�- �. Zip <br /> ENVIRONMENTAL I-ILMM 9( <br /> DEPARTMENTHauter Registration#(if hauled as hazardous) <br /> EH 23 046 (Revised 10/30/12) 4 <br />