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SANJ O A Q U I N Environmental Health Department <br /> - <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 [I NO [ ] <br /> 3 . Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [x] YES [ ] NO [ ] If YES, Permit # <br /> 4 . Has the contractor obtained approval from the local fire department to perform tank cutting ? NA[x] YES f ] 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 # CAR000189431 <br /> Address 406 E Alondra Blvd City Gardena Zip 90248 <br /> Phone # ( 310 523 - 4430 <br /> 7 , Decontamination Procedures : <br /> a . Will tank(s) and piping be decontaminated prior to removal ? Closure YES [ ] NO [ ] <br /> b . Identify contractor performing decontamination: <br /> Name Adams Services Inc <br /> Address 406 E Alondra Blvd City Gardena Zip 90248 <br /> Phone No. ( <br /> G6 Desibe, mefhod to qe used for decontamination : <br /> triple clean <br /> d . Describe how rinsate material will be stored onsite prior to manifesting offsite : <br /> Vac Truck <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Adams Services Inc Hauler Registration # CAR000189431 <br /> Address 406 E Alondra Blvd City Gardena Zip 90248 <br /> Phone No . 310 ) 523 - 4430 <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 /> Tank and pipinq will be triple cleaned and verified by a marine <br /> G�m � ct <br /> b . Tank/Piping Hauler: <br /> Name Adams Services Inc <br /> Address 406 E Alondra Blvd City Gardena Zip 90248 <br /> Phone No . ( 310 523 - 4430 <br /> Hauler Registration # (if hauled as hazardous) CAR000189431 <br /> 4of10 <br />