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SANJOAUI R <br />NQi Environmental Health Department <br />COUNTY EC'. <br />OCT 0 2018 <br />1. (a) is the current certificate of worker's compensation insurance on file? YE j NO[ ] <br />b Does the contr oval Certification"? YE NO <br />(c) Has everyone tie incRJV'MPeNb;TLAjr�Mt%tD%e certified to work on YESPQ NO ( j <br />hazardous waste sites i9TTitle 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 VW YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ j YES [ j NOYL <br />6. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES f ] NO <br />8. <br />6. if tank residual a <br />C MX <br />Name <br />Address, <br />Phone # <br />7 <br />`Tpjxs w ( W41 1 bac,. <br />fiauter Registration # w �� 5 <br />Cityy_ ` 1 Zip _ <br />Decontamination Procedures: <br />a. Will lank(s) and piping be decontaminated prior to removal? YES [)L NO[ j <br />b. Identify contractor performing decontamination: <br />Name L—C S-*-P%A t -e5 <br />Address 3%$ ^2 w - City w, Zip gn'?Zz <br />Phone No.( S -5"`i <br />C. De cr+be rpethod to bp used for decont minati n: <br />d. Descripe how ri sate material will be stored on ite prior to manifesting ff ite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name.ail avor.-/Hauler Registration # L 0 f7 L S'3 -t t 7 <br />Address 7i 10-7 ! TOL-141'eCe.,4" A.— City Zip b! V <br />Phone No. ( ) ®" 9�0 C <br />Permitted Dispos I Site ib v\ �+ V O 6 d 13 <br />J 35zp_ <br />2.6t9Qt <br />a. Describe the methoo that will be utilize t pand/o Wert the tank ): <br />j 1 7 <br />.� ,e y <br />b. Ta ipin��w�// aule//r: <br />Name &ler " of OCtS ,,r �s <br />Address City Zip <br />Phone <br />Hauler Registration # (if hauled as hazardous) <br />?)e_WU,_ <br />_ea o - <br />co <br />'(1A `AN—z5 <br />8 <br />