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SANJ O A Q U I N Environmental Health Department <br /> C OU N TY ----- --- <br /> 1 . (a ) Is the current certificate of worker's compensation insurance on file? YES NO [ ] <br /> (b) Does the contractor possess a " Hazardous Substance Removal Certification " ? YESNO [ ] <br /> (c) Has everyone on site , including crane/backhoe operator, been certified to work on YES 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 X NO [ ] <br /> 3 . Hasapplicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A YES [ ] NO [ ] If YES , Permit # <br /> 4 . Has the contractor obtained approval from the local fire department to perform tank cutting ? NAV] 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 Nieto and Sons Trucking , Inc . Hauler Registration # 0503 <br /> Address 1281 Brea Canyon Road City Brea Zip 92821 <br /> Phone # ( 714 ) 990.6855 <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 Belshire Environmental Services , Inc . <br /> Address 25971 Towne Center Drive City Foothill Ranch Zip 92610 <br /> Phone No . ( 949 ) 460=5200 <br /> c. Describe method to be used for decontamination : <br /> High pressure washer utilizing wash water with a surfactant. Both product lines and tanks will <br /> e rinsed until tanks are clean . Tanks will a inerrted with ry Ice. <br /> d . Describe how rinsate material will be stored onsite prior to manifestinoffsite: <br /> Rinse water will be managed as hazardous waste and will be frans orted offsite utilizing a <br /> vacuum truck . No onsite storage ot waste will occur. <br /> e . Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Nieto and Sons Trucking , Inc . Hauler Registration # 0503 <br /> Address 1281 Brea Canyon Road city Brea Zip 92821 <br /> Phone No. ( 714 ) 990-6855 <br /> Permitted Disposal Site Demenno Kerdoon (World Oil ) 2000 N . Alameda Street, Compton CA <br /> 8 . a . Describe the method that will be utilized to purge and/or inert the tank(s ): <br /> High pressure wash unit will wash from existing tank openings . Pressure washer will utilize tap <br /> water with a surfactant. Water will be collected by vacuum truck. Dry ice will be added to tanks . <br /> b . Tank/Piping Hauler: <br /> Name Belshire Environmental Services , Inc . <br /> Address 25971 Towne Center Drive city Foothill Ranch Zip 92610 <br /> Phone No. ( 949 ) 460=5200 <br /> Hauler Registration # (if hauled as hazardous) Tank and pipe to be managed as non-hazardous . <br /> 4of10 <br />