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Y <br /> (b) Is the current certificate of worker's compensation insurance on file? -� ��L� FS[4]�NO <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"7a4a& - ES NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified tq work on <br /> (e) hazardous waste site in accordance with CCR Title 8? E)ES MkaCa �= YES[�]� NO [] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted?---aA"-CV El YES[ NO[J <br /> 3. Has ap9licant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N13 M YES [] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[J YES[J NO[J <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: JA''(Ze-J <br /> Name Hauler Registration# <br /> Address City zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES V' NO[] <br /> b. Identify contractor performing decontamination: <br /> Name 1 C VC h C.. <br /> Address ���dEp �gL Cih9ycATPUi1C�x)zip G40B a <br /> PhoneNo.( q5z—G�591 <br /> C. E2ascribe method to be used for dec nt ation: J _1 <br /> hilel �Il t e vv% �� i h - ���L� (.{ <br /> 5 �► v <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, <br /> Storage&Disposal Facility: <br /> Hauler Name 0�0`w \._OY1Ti�R3, YIC#, Hauler Registration# CAD q82 ®3 1-73 <br /> Address �� � �!�. City GYl N-N ip '1413® <br /> Phone No. ( 11239 — \3q,3 <br /> Permitted Disposal Site IES pJ3 <br /> EH 23 046 (Revised 10/16/03) Page 4 <br />