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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 Pr 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 ,$ ' NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? A f -ke- la YESM- NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? fo <br />N/A [I YES [ ] NO [ ] If YES, Permit # f �bhv rr/xr'1a� t fOr 5J(ac(,v <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? N ES[ ] NO[ ] <br />/V,4 l -44'r- GV AI" <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br />Nk,Dwq/ <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />c/FD <br />Name Le- Ln Hauler Registration* <br />Address 7-65- Po -r 15104 City P lle A Zip <br />Phone # ( 57 tD ) 235 - 131 3 <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES,k- NO [ ] <br />b. Identify contractor performing decontamination: <br />Name kFc -L <br />Address-Z-T.5- A4 etf XV 61 City A k AMoAad Zip ?W41 <br />Phone No.(_Sl.O ) 235-- 13 13, <br />C. Describe method to be used f?r decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: C �� <br />Hauler Name C G-�— Hauler Registration # [ 82y3 V In <br />Address �'SS PC ►^ �'' �►'t� City /'tie, At"w Zip f 11V <br />Phone No. <br />Permitted Disposal Site 0 YN i e- 7 <br />EH 23 046 (Revised 10/ 16/03) Page 4 <br />