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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 [ ] 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 [K] NO [ ] <br /> 3 . Has applicant performing removal in the City of Tracy obtained a " Grading and Excavation Permit"? <br /> N/A [R] YES [ I NO [ ] If YES , Permit # <br /> 4 . Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES [X] NO [ ] <br /> 5 . Is there knowledge or evidence of leakage from the tank(s ) and/or piping? (If yes , please explain ) YES [ ] NO M <br /> 6 . If tank residual exists , identify transporting hazardous waste hauler: <br /> Name American Valley Waste Oil Hauler Registration # 3744 <br /> Address P . O . Boc 340 City Delhi, CA zip 95315 <br /> Phone # ( 800 ) 7324645 <br /> 7 , Decontamination Procedures : <br /> a . Will tank(s ) and piping be decontaminated prior to removal ? YES [X] NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Valued Engineering <br /> Address 10409 LoneStar City Stockton zip 95209 <br /> Phone No . ( 209 ) 477 - 4500 <br /> C4 De crib rnetho� to b used f r dei amination : <br /> ASny11 Ul in the tank wift e removed with a vacuum truck. The tank will be <br /> trTP rinsed usinga green gleaning liquid such as " Simple Careen <br /> d . De rjbe how rinsate atq i will be stor d on to pri re umesttru� S'immediatel . If materical <br /> Manse materia`lwiclt e trans ferred to t� c <br /> is e t on site it wi e store in DOT - appove 55 - ga on rums <br /> e . Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name American Valley Waste Oil Hauler Registration # 3744 <br /> Address P . O . Box 340 city Delhi, CA zip 95315 <br /> I <br /> Phone No . ( 800 ) 732 -4645 <br /> Permitted Disposal Site DK Dixon, 7300 Chevron Way, Dixon , CA, 95620 (EPA CAT080012602) <br /> 8 . a . Describe the method that will be utilized to purge and/or inert the tank(s) : <br /> 15 pounds of dry ice per 500 - gallon tank will be use to " inert" the UST <br /> b . Tank/Piping Hauler: <br /> Name West Coast Equipment <br /> Address P . O . Box 2368 cityTurlock, CA zip 95381 <br /> Phone No , 800 ) 441 - 8544 <br /> Hauler Registration # (if hauled as hazardous ) N/A Tank will be transported as Non -Haz. <br /> 4of10 <br />