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SANJ O A Q U I N Environmental Health Department <br /> COUNTY�- <br /> 1 . (a) Is the current certificate of worker's compensation insurance on file? YES [x ] NO [ ] <br /> (b) Does the contractor possess a " Hazardous Substance Removal Certification" ? YES [x ] NO [ ] <br /> (c) Has everyone on site, including crane/backhoe operator, been certified to work on YES [x] NO [ ] <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 W NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a " Grading and Excavation Permit"? <br /> N/A (K] YES [ ] NO [ ] If YES , Permit # <br /> 4 . Has the contractor obtained approval from the local fire department to perform tank cutting? NAC ] YES [ ] NO [ ] <br /> 5 . Is there knowledge or evidence of leakage from the tank(s) and/or piping ? (If yes , please explain) YES [ ] NO [x] <br /> 6. If tank residual exists , identify transporting hazardous waste hauler: <br /> Name Adams Services , Inc . Hauler Registration # 3216 <br /> Address 406 E . Alondra Blvd , City Gardena , CA Zip 90248 <br /> Phonefl( 310 ) 5234430 <br /> 7 , Decontamination Procedures : <br /> a . Will tank(s) and piping be decontaminated prior to remov II ? YES [)q NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Adams Services , Inc . <br /> Address 406 E . Alondra Blvd , City Gardena , CA Zip 90248 <br /> Phone No. ( 310 ) 5234430 <br /> C, Describe method to be used for decontamination : <br /> Triple rinse tank using hi -gh pressure water. <br /> d . Describe how rinsate material will be stored onsite prior to manifesting offsite : <br /> Goes directly from tank to tanker truck . <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Adams Services , Inc . Hauler Registration # 3216 <br /> Address 406 E . Alondra Blvd , City Gardena , CA Zip 90248 <br /> Phone No . ( 310 ) 5234430 <br /> Permitted Disposal Site World Oil Recycling <br /> 8 . a . Describe the method that will be utilized to purge and/or inert the tank(s) : <br /> DrV ice will be laced in the tanks at a rate of 25lbs/ 1000 al . tank ca acit tanks are <br /> considered inerted once oxygen level isbelow 0 ° ° . <br /> b . Tank/Piping Hauler: <br /> Name Adams Services , Inc. <br /> Address 406 E . Alondra Blvd . City Gardena . CA zip 90248 <br /> Phone No. ( 310 ) 5234430 <br /> Hauler Registration # (if hauled as hazardous) 3216 <br /> 4of10 <br />