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t. (a) Is the current certificate of worker's compensation insurance on file? YES)< NO[I <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YESf4 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'( NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES)( NO[] <br /> 3. Hasap licant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/AK YES[] NO(] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N/q�`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. <br /> Name_ U NI W,4 S T"6 Hauler Registration#_ _ <br /> Address 1-7 t o D L A M B rLrLT- R.D. City :r6116. zip q S6 4 a <br /> Phone# '2• 2"i i{ — 6 S3i; <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES- NO[] <br /> b. Identify contractor performing decontamination: <br /> Name C-L Es 4R W,4 T-C 12 <br /> Address P 0. Igo y 2-440-7 City wio N/ C ITy zip qja7 _ <br /> Phone No.( '713 - 6757 <br /> C. Describe methgd to be used for decontaminati n: <br /> -MIPL-S 2(O►s& w� Aor (Jkr X A-VD Sd,4P <br /> d. Describe how rinsate material will be stored onsite prior to manifestnq offsite: <br /> VA C-V0 M Env r-7 <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name v N tw,'�sr'E Hauler Registration 0�4q ig_ <br /> Address 1 10 0 L,cEM q Cl/Li sip. City�� zip Cl f(o +U <br /> Phone No. ?'0� " 6 53(a <br /> Permitted Disposal Site MZU 4-rctt. 3-43o A L"o w o OA. , Sl s-VAPI SPRM-I;,, AA1 <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): I�R, ' fr <br /> b. Tank/Piping Hauler. <br /> Name ,SVA,r /AI —,P1/+cC <br /> Address City Zip <br /> Phone No.( ) <br /> Hauler Registration#(if hauled as hazardous) <br /> EH 23 046 (Revised 07/22/10) 4 <br />