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SAN JOAO IN <br />COU NTY <br />Environmental Health Department <br />1. (a) Is the current certificate of worker's compensation insurance on file? <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 [M NO [ ] <br />hazardous waste sites in accordance with CCR Title 8? <br />2. Hasa "Site Health &Safety Plan" for this job site been submitted? YES ]iQ NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A [M 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 tanks) and/or piping? (If yes, please explain) YES �Q NO [ ] <br />Impacted soil around permiter of tank Impacts below tank are unknown at this time. <br />Impacts to groundwater are unknown at this time. <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name Naman Trucking Hauler Registration # 5164 <br />Address 411 Acacia St., Unit B city Tracy zip 95376 <br />Phone #( 209 ) 321-0319 0 A P�cru �� 41 q0 <br />7. Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to removal? YES [xj NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Costera Waste & Environmental, Inc. <br />Address 14 EI Vaquero <br />City <br />c. <br />d. <br />e. <br />Phone No.( 415 <br />533-0112 <br />)e method to be used for d <br />e rinse with hot water <br />nt. <br />Df�in este w II �e pumpedlin vacuumntruc�Crorts <br />Margarita zip <br />• •f2 <br />re rinseate with vacuum truck or in <br />n steel UN DOT <br />Rinsate Hauler and permitted Treatment, Storage &Disposal Facility: <br />Hauler Name Naman Trucking Hauler Registration # 5164 <br />Address 411 Acacia St., Unit B city Tracy zip 95376 <br />Phone No. ( 209 ) 321-0319 <br />Permitted Disposal Site World Oil <br />Describe the method that will be utilized to purge and/or inert <br />b. Tank/Piping Hauler: <br />Name Naman Trucki <br />Address 411 Acacia St., Unit B <br />Phone No. <br />321-0319 <br />Hauler Registration # (if hauled as <br />5164 <br />4of10 <br />the tank(s): <br />city Tracy ziP 95376 <br />eted. <br />