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r <br />(b) Is the current certificate of worker's compensation insurance on file? — ,AAeA ES me NO <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"?aLES W NO [ ] <br />(d) Has everyone on site, including crane/backhoe operator, been certified t work on <br />(e) hazardous waste site in accordance with CCR Title 8? GE.E a.�4acnC:4 YES [y]� NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? — aA,&r-NAA YES [4]� NO [ ] <br />3. 'Has ap9licant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A M YES [I NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO[ ] <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:-4-lke-(A s, <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 &J" NO [ ] <br />b. <br />EGA <br />Identify contractor performing decontamination: <br />Name ' <br />Address <br />Phone No.( G9b ) C 5Z—G J 91 <br />to be used for dec nt ation: <br />�t �c� r tr a VY �� � Pa + V% � �- C� I <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Si ate a 41 Units <br />e. Rinsate Hauler and permitted Treatment, Storage j& Disposal Facility: <br />Hauler Name Cot O Cly Y1 , 1Y1Ci� Hauler Registration # �:� q82 ®3 c) 1-73 <br />Address 25o �[ d. City G� r <br />iv 4- ,501 <br />Phone No. ( Vo 23 9" i 3 g 3 <br />Permitted Disposal Site `' Es — 1 C93 3 <br />EH 23 046 (Revised l0/16/03) Page 4 <br />