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1. (a) Is the current certificate of worker's compensation insurance on file? YES[I NO[] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certlfiration"? YES U 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[] <br /> 2. Has a'Site Health&Safety Plan"for this job site been submitted? YES[A NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[] YES[] NO[A If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA14 YES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes, please explain)YES[] NO N <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name American Valley Waste Oil Hauler Registration# 3744 <br /> Address P. O. Box 340 City Delhi, CA Zip 95315 <br /> Phone#( 800 ) 732-4645 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[A NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Advanced GeoEnvironmental, Inc. <br /> Address 837 Shaw Road City Stockton Zip 95215 <br /> Phone No.( 209 )467-1006 <br /> C. Describe method to be used for decontamination: <br /> Any nominal liquid in tank will be removed via vacuum truck then tank will be triple-rinsed using <br /> a green cleaning agent such as"Simple Green" <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinseate will be stored in 55-9allon DOT drums or removed immediately using a vacuum truck. <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name American Valley Waste Oil Hauler Registration#3744 <br /> Address P. O. Box 340 City Delhi, CA Zip 95315 <br /> Phone No. ( 800 )732-4645 <br /> Permitted Disposal Site DK Dixon, 7300 Chevron WAy, Dixon, CA 95620 (EPA CAT080012602) <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> 15 lbs of dry ice per 500-gallons of tank volume will be used to"inert"the UST. <br /> b. Tank/Piping Hauler: <br /> Name West Coast Equipment <br /> Address P. O. Box 2368 City Turlock, CA Zip 95381 <br /> Phone No.( 800 ) 441-8544 <br /> Hauler Registration#(if hauled as hazardous) N/A <br /> EH23046 (Revised8/I/II) 4 <br />