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1. (a) Is the current certificate of worker's compensation insurance on file? YES V Np[] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YES 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[4" NO[J <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES[( NO[] <br /> 3. Has ap licant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A V YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NPeYES[J NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO[Yl <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name ADAMS SERVICES INC Hauler Registration#3216 <br /> Address 406 EAST ALONDDRA BLVD City GARDENA Zip 90248 <br /> Phone#(310 )523-4430 <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 ADAMS SERVICES INC <br /> Address 406 EAST ALONDDRA BLVD City GARDENA Zip 90248 <br /> Phone No.(310 )523-4430 <br /> C. Describe method to be used for decontamination: <br /> TRIPLE RINSE <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> IMMEDIATELY REMOVED BY VAC TRUCK <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name ADAMS SERVICES INC Hauler Registration#3216 <br /> Address 406 EAST ALONDDRA BLVD City GARDENA Zip 90248 <br /> Phone No. (310 )523-4430 <br /> Permitted Disposal Site DEMENNO/KERDOON-2000 N ALAMEDA STREET, COMPTON,CA <br /> 8 a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> USING 30 LBS/1000 GALLON CAPACITY DRY ICE TO INERT TANKS AFTER TRIPLE RINSE <br /> b. Tank/Piping Hauler: <br /> Name ADAMS SERVICES INC <br /> Address 406 EAST ALONDDRA BLVD City GARDENA Zip 90248 <br /> Phone No.(310 )523-4430 <br /> Hauler Registration#(if hauled as hazardous)3216 <br /> EH 23 046 (Revised 07/22/10) 4 <br />