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(b) Is the current certificate of worker's compensation insurance on file? YES,W NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES P' NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> (e) hazardous waste site in accordance with CCR Title 8? YES 11- NO[] <br /> 2. Has a"Site Health&Safety Plan"for thisjob site-been submitted? A f `` ked YES ]' NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? f-0 <br /> N/A[] YES[] NO[] If YES, Permit# f�bmiTCXr'Wt i t 5 ,u(c�,ri <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N ES[]NO[] <br /> /UG �-4 it P_ ew <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO[] <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Le-LHauler Registration# `l?'-w3 e 173 <br /> n <br /> Address 2-6 S f o-rCity Pee <br /> e�►'►'to'� Zip y qd6 1 <br /> Phone#( 57 tO ) x--35' (313 <br /> Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES,61- NO[] <br /> b. Identify contractor performing decontamination: <br /> Name 0C X_ <br /> Address ��� A ep, ^ City /"�6�GA1 j'►�0,I& Zip <br /> Phone No.(� L_) 2-77 ' !3 1 3 <br /> C. Describe method to be used f?r decontamination: <br /> r�hgC- <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> V-RC_ NvG(L, <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: e �v <br /> Hauler Name C G= Hauler Registration# 1 g _03 0173 <br /> Address A w City I?i C4 M_ t Zip f <br /> Phone No. (- 1 D ) -2 - 13 ?-3 <br /> Permitted Disposal Site R D m l L eAP d 0?y6`)-45 7 <br /> EH 23 046 (Revised 10/16/03) Page 4 <br />