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Webb S . AdieF <br /> k P U. ��uxtas, tki CeyTle r <br /> SANAI I <br /> J O A O U I N Environmental Health Department <br /> COUNTY <br /> �aJ els the current certificate of worker's compensation Insurance on file? YES [' J NO [ j <br /> oes the contractor possess a "Hazardous Substance Removal Certification'? YES [ J NO of j <br /> C (c) ' as everyone on site, Including crane/backhoe operator, boon certified to work on YES [ ] NO [ ] <br /> hazardous waste sites In accordance with CCR Title a? i <br /> -2 Has a "Site Health & Safety Pian" for this job alta been submitted? <br /> YES [ ] NO [ ) <br /> 3: Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit,'? <br /> N/A [ I YES ( ] NO [ J If YES, Permit # <br /> • r <br /> Has the contractor obtained approval from the local fire deparlrhent to perform tank cutting? NA[ ] YES [ ] NO ( ) <br /> 6: Is there knowledge or evidence of leakage from the tank(s) and/or. plping? (If yes, please explain) YES [ ] NO ( ] <br /> i <br /> 8 If tank residual exists, Identify transporting hazardous waste haler: + <br /> L Name � 4, <br /> vv V� r' f` Nva Hauler Registration # <br /> Addres <br /> Clly� . v, avt„ Zlp <br /> \ Phone # <br /> i- ) Decontamination Procedures , <br /> Will tank(s) and piping be decontaminated prior to re oval? <br /> YES [ ] NO <br /> ,(fib, s Identifycontractor performing decontamination; i <br /> Name <br /> Address � riisr' eYClty — � Zip <br /> Phone No. <br /> G / .,c. Describe method to be used for decorlteminatlon.d <br /> d t lookJ-t�l�_� i .•�' �,- r �- 1. , e ✓' <br /> & ALM1 , <br /> AMP <br /> do Describe how ripsate material will be stored on rior to manifesting offsite: <br /> e. .j Rinsate Hauler and permitted Treatment, Storepe & Disposal Facility: * i✓ Cp•}1 orb 1.LC. vT <br /> Hauler Name n IW i ru Hauler Registration # _ <br /> Address 157J •- City _ J &e Pip ?TSI' r! `- r <br /> Phone No. 1292 <br /> 1 <br /> eA Permitted Disposal Site ) <br /> tosAn olo�, <br /> Describe the method that will be utilized to purg ndlor ine�t the tank 9bD�`' <br /> . I � h <br /> Tank/PipingHaulen <br /> Name i <br /> Address zip <br /> Phone No.(_ <br /> Hauler Registration # (If hauled as hazardous)__ }� <br /> 4of10 <br /> I <br /> ,I <br />