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t . (a ) Is the current certificate of worker's compensation insurance on file? YES �(<} NO [ j <br /> (b ) Does the contractor possess a "Hazardous Substance Removal Certification"? YES PJ NO [ ] <br /> (c) Has everyone on site , including crane/backhoe operator, been certified to work on YESJJ 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 NO [ ] <br /> 3 . Has applicant 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] ']• YES [ ] NO [ ] <br /> 5 . Is there knowledge or evidence of leakage from the tank(s ) and/or piping ? (If yes, please explain ) YES [ ] NO `G <br /> 6 . If tank residual exists , identify transporting hazardous waste hauler: <br /> Name / � 1 �( ��Z J(, 5 Hauler Registration # r <br /> Address.1 i5oa c- 3 City I f Zip <br /> Phone # ( _) (� <br /> 7 . Decontamination Procedures : <br /> a . Will tank(s ) and piping be decontaminated prior to removal? YEE&`k NO [ ] <br /> b . Identify contractor performing decontamination: <br /> Name _; Z, / 2 i, (14 r°AJ& <br /> Address 0)vfs*� f City 6G�'t7 <br /> J Zip 1 _ <br /> Phone No . ( ) 3 <br /> C, Describe method/ to beused for deconta�miinatio6n : dd�We ��^�� � �® 7XIA /0 ?2 ��s✓' F� �e�sjfi �� <br /> 54G qd Z,/rl 4y �d111 /�'�✓ 7 � �X� 71 de <br /> d . Describe how rinsateate,�rial will be stored onsite prior to manifesting offsite : r r <br /> r <br /> e . Rinsate Hauler and permitted' Treatment, Storage & /Disposal Facility: <br /> Hauler Name 17 ( CAJ Hauler Registration # _ <br /> Address e .3 Yt0 City rZ, _ Zip— <br /> Phone No . (�) 7 � q � t <br /> Permitted Disposal Site f) A� D �(19A1 � ..a00 4f2{5!/ ee100 a� K.�✓L01 �%L1164)Z <br /> 8 . a . D scribe the methoo tht will e utili ed to pie and/or ine the tank(s): <br /> Pic <br /> J <br /> b . Tank/Piping Hauler: <br /> Name �" dr ��.e <br /> Address_F f74t <br /> om 35Z <br /> City r'' Zip _ 957 <br /> Phone No , <br /> d' 6l <br /> Mauler Registration # (if hauled as hazardous ) °df�d (�� ir��'/���+� � )/yz&i`fow d � <br /> 4 of 10 <br />