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Environmental Health Department <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. Hasa "Site Health &Safety Plan" for this job site been submitted? YES [� NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"7 <br />N/A [I 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 Pipingg? ((If yyes, please explain) YES [ ] NO <br />NO KNOWLEDGE OR EVIDENCE OF LEAKAGE FROM THE TANK. THE NK WAS RECENTLY DISCOVE D <br />DURING TRENCHING FOR A NEW STORM DRAIN <br />6. <br />7 <br />b. <br />If tank residual exists, identify transporting hazardous waste hauler: <br />AMERICAN VALLEY WASTE OIL <br />Hauler Registration # 3744 <br />Address PO BOX 340 City DELHI <br />Phone # ( 95315 <br />800 ) 7324645 <br />Decontamination Procedures: <br />b. <br />c. <br />D <br />e. <br />Witl tanks) and piping be decontaminated prior to removal? <br />Identify contractor performing decontamination: <br />Name ADVANCEDGEO, INC <br />Address 837 SHAW ROAD <br />Phone No.( 209 <br />467-1006 <br />City STOCKTON <br />Zip 95215 <br />Describe method to be used for decontamination: <br />ANY NOMINAL LIQUID IN TANK WILL BE REMOVED VIA VACUUM TRUCK. THE TANK WILL BE <br />TRIPLE -RINSED USING A PRESSURE WASHER AND CLEANING AGENT (E.G. SIMPLE GREEN) <br />Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />RINSE MATERIAL WILL BE IMMEDIATELY TRANSFERRED TO VACUUM TRUCK FOR DISPOSAL. <br />IF NECESSARY, RINSE WILL BE PLACED INTO D.O.T:RA TED 55 -GALLON DRUMS <br />Rinsate Hauler and permitted Treatment, Storage &Disposal Facility <br />: <br />Hauler Name AMERICAN VALLEY WASTE OIL Hauler Registration # 3744 <br />Address P.O. BOX 340 City DELHI Zip <br />Phone No. ( 800 ) 732-4645 <br />Permitted Disposal Site DK DIXON, 7300 CHEVRON WAY, CIXON CA 95620 (EPA CAT080012602) <br />Describe the method that will be utilized to purge and/or inert the tank(s): <br />15 LBS OF DRY ICE PER 500 -GALLON TANK VOLUME WILL BE USED TO INERT THE TANK <br />Tank/Piping Hauler: <br />WEST COAST EQUIPMENT <br />Address P.O. BOX 2368 Cid, TURLOCK Zip <br />Phone No. 8( 00 ) 441-8544 <br />95381 <br />Hauler Registration # (if hauled as hazardous) N/A -TANK WILL BE HAULED NON -HAZARDOUS <br />4of10 <br />