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SAN OAQUI <br /> I 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 I' (j NO [ j <br /> (c) Has everyone on site, including crane/backhoe operator, been certified to work on YES [4 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 /> One plan from Ponder Environmental Services and a second plan by GWR Southwest . <br /> 3 . Has plicant 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 ? NA[X] YES [ ] NO [ ] <br /> 5 . Is there knowledge or evidence of leakage from the tank(s) and/or piping ? (If yes , please explain) YES [ ] NO (� <br /> 6. If tank residual exists , identify transporting hazardous waste hauler: <br /> Name Ponder Environmental Services Hauler Registration # CAR000180737 <br /> Address P . O . Box 1427 city Benicia , CA Zip 94510 <br /> Phone # ( 707 ) 748-7775 <br /> 7 . Decontamination Procedures : <br /> a . Will tank(s) and piping be decontaminated prior to removal ? YES M NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Ponder Environmental Services <br /> Address P . O . Box 1427 city Benicia , CA Zip 94510 <br /> Phone No . ( 707 ) 748-7775 <br /> Go Describe method to be used for decontamination : <br /> Triple rinsed with high pressure washer <br /> d . Describe how rinsate material will be stored onsite prior to manifesting offsite : <br /> Evacuated from UST directly into vacuum truck . <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Ponder Environmental Services Hauler Registration # CAR000180737 <br /> Address P . O . Box 1427 City Benicia , CA Zip 94510 <br /> Phone No . ( 707 ) 748-7775 <br /> Permitted Disposal Site Potrero Hills Landfill <br /> 8. a . Describe the method that will be utilized to urge and/or inert the tank(s) : <br /> Flushing lines and triple rinse tan �C with high pressure water. Recovery <br /> of fli dds withyari n im tri irk <br /> b . Tank/Piping Hauler: <br /> Name NA - decommission in place <br /> Address City Zip <br /> Phone No . ( ) <br /> Hauler Registration # (if hauled as hazardous) <br /> 4of10 <br />