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(b) Is the current certificate of worker's compensation insurance on file? YES NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES 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�K NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? AT`rACHLZ) YES NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Perms"? 1 <br /> N/A [] YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA)d YES[] NO[] <br /> N- <br /> 5. Is there knowledge or evidence of leakage fr'o/m the tank(s)and/or piping? (If yes,please explain)YES'$ NO[] <br /> wl <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: exp <br /> Name Hauler Registration# 9?'Z 40 3c)l-7 <br /> Address .Z �-s / AQQ B�Y`7 . City <br /> in <br /> 9¢g0/ <br /> Phone#( Si O <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESX NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address -z �-S / A2 Q a`'✓y, City. K'G~` zip %¢lp0/ <br /> Phone No.( S"/ <br /> C. Describe method to be used for decontamination: <br /> 00 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> 4 C IzeaC A- <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: f A <br /> Hauler Name C Hauler Registration# 9�.Zy <br /> Address Z 575 /AL R. -L;>-1;:�2 City 15.?C zip 5;W0� <br /> Phone No. 0 ) Z ? . /SP 3 <br /> Permitted Disposal Site 160H/6 121(2:)OOq¢ SZ ,S42-, <br /> EH 23 046 (Revised l0/16/03) Page 4 <br />