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SAN-JOAQUIN <br />COUNTY <br />t <br />.: C � (,a <br />1VRU <br />Environmental Health Department <br />OCT 10 2018 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />1. (a) Is the current certificate of worker's compensation insurance on file? YE j NO [ j <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? YE&M NO[ ] <br />(c) Has everyone on site, including crane/backhoe operator, been certified to work on YES PC NO [ l <br />hazardous waste sites In accordance with CCR Title 8? <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YESX NO [ ) <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A & YES [ I NO [ I If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ l YES [ l NO <br />5. is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain) YES O NO <br />r. <br />6. if tank residual a fists, Identify transoortinq hazardous waste hauler: "� j( t h ( W <br />c�LltM(Q OJ C 1 <br />T Na a Hauler Registration # <br />Address ' City�-- <br />Phone <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [jl, NO[ I <br />b. Identify contractor performing decontamination: <br />Name L4- wES <br />Address ?St,$ q City 4�Zip3�2-Z- <br />Phone No. , tit" q — l'2 3o <br />a Descrierpethod to bpusefor dmalig <br />�-ps-v.1 n <br />d. Descn a how <br />ri sate material will be stored on ite prior to manifesting Qff�ite* <br />f3/RGC�.7 /'el�a 111,111 v4c"-da at <br />A-2 . <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler NameytiaAt t#a t Hauler Registra_tiion # <br />Address 7,171-71 l m -e (-c,4" N- City 1.44 T Zip '72 11a! 17 <br />Phone No.( �9 q, ) c 0— S-�o® <br />s <br />Permitted Dispospi Site_' <br />2boO M <br />S. a. Describe the metho that will be utilized <br />b. Ta tpin aider: <br />R <br />OW <br />Name Rlej-l- &)4S-/ ZMA <br />Address City Zip <br />Phone No.( ) <br />Hauler Registration # (if hauled as hazardous) <br />2� 91, ( ` ijwue_ � J,j a oto .. <br />�icL t <br />C+ C1 M Y� <br />L, bo <br />cmmti 3 <br />6157 .� <br />