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REC.-YENM <br /> Environmental Health Department <br /> SANJOAQUIN OCT 10 2018 <br /> COUNTY <br /> I 'T L <br /> OUNTYIRONMENTAL HEALT1. H <br /> DEPARTMENT <br /> (a) Is the current certificate of worker's compensation insurance on file? SeYE ) NO <br /> NO <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YE NO[ I <br /> (c) Has everyone on site,including crane/backhoe operator,been certified to work on YES P4 NO I ] <br /> hazardous waste sites in accordance with CCR Title 8? <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES X NO <br /> 3. Has ficant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA 9 YES I I NO[I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[ I YES I I NO V1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (if yes,please explain) YES I I NO <br /> 6. 1 h I -T <br /> If tank residual ellsts,Identify transDorlinc, azar waste pu user: W14 <br /> YOML <br /> a <br /> Hauler Registration# <br /> N <br /> Address ® City_ Zip .ql� <br /> Phone 92��� <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[)L NO( <br /> b. Identify contractor performing decontamination: <br /> Name. L-C- <br /> Address TIM") City zip <br /> Phone No.C,4��� SSW, LOM—Il 30 <br /> C. De cribs rpethDd to bp used r econ mination: <br /> lr�E4 $4 (e <br /> _ <br /> d. Descrie how * satematerial 1,11 be store on I e nor to manifesting f Ite: <br /> C-2 <br /> 0 44lift <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> HaulerHauler Registration <br /> Address 4(4 Ae city ICE zip &7Z of 17 <br /> Phone No.( 9qj <br /> PermittedDispill Site <br /> a. Describe the meth(%that will utilize I Puy and/or inert the tan <br /> A IA,& (/Sx.� <br /> it <br /> IL 4C <br /> b. Ta 11 auler: <br /> Name <br /> Address— City_ Zip <br /> A t)— 0 <br /> ite <br /> 11 be Util!Z' an� ne <br /> Name <br /> Address <br /> Phone No.( N <br /> Z <br /> Hauler <br /> auler Registration#(if hauled as hazardous) <br /> 0 S�� <br /> 4o <br /> GAL- <br /> C,+ <br /> �co <br />