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I , <br /> 9255517899 Line 0- ':07p.m. 11-04-2010 4/13 <br /> 1. (a) Is the current certificate of worker's compensation insurance on file? YES V NQ[] <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[1� NO[j <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES&( NO[] <br /> 3. Has applicant 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?NWYES[] NO[j <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 NIETO AND SONS TRUCKING INC. Hauler Registration#0503 <br /> Address 1281 BREA CANYON ROAD CityBREA Zip 92821 <br /> Phone#(714 )990.6855 <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 NIETO AND SONS TRUCKING INC. <br /> Address 1281 BREA CANYON ROAD City BREA Zip 92821 <br /> Phone No.(714 )990-6855 <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 NIETO AND SONS TRUCKING INC. Hauler Registration#0503 <br /> Address 1281 BREA CANYON ROAD City BREA Zip 92821 <br /> Phone No. (714 )990.6855 <br /> Permitted Disposal Site CLEANHARBORS <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 NIETO AND SONS TRUCKING INC <br /> Address 1281 BREA CANYON ROAD City BREA Zip 92821 <br /> Phone No.(714 )990.6855 <br /> Hauler Registration#(if hauled as hazardous)CAT080016116 /o 0 <br /> EH 23 046 (Revised 07/22/10) 4 <br />