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SA N J O A Q U l N Environmental Health ❑epartinent <br /> -COU 1\1TY <br /> 1, [a] Is the current certificate of worker's compensation insurance on file? YES[)d NO[ ] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Carl]ficatlon"? YES[x] NO[ ] <br /> (c) Has everyone on site,including cranelbackhoe operator,been certillad to work on YES[x) NO[ <br /> hazardous waste sites In accordancewilh C C R Title 6? <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES f) NO[] <br /> 3, Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[J YES[I NO[) If YES, Permit# <br /> 4. Has the contractor obtained approval from the Iocal fire department to perform lank cutting?NAl ] YES[A NO[ ] <br /> 5. Is there knevAedga or evidence of leakage from the tank(s)andlor piping? (It yes,pi ease explain) YES{ ] NO�] <br /> 6. If lank residual exists,identify transporting hazardous waste hauler <br /> Name Environmental Logistics (tauter Registration# <br /> P❑ Box BOB Colton 92324 <br /> Address City. Zip <br /> Phone#( t 0-679-990t <br /> 7. Decontamination Procedures: N/A <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[ ] NO[ ] <br /> b. Identify contractor performing decontaminat]on: <br /> Name <br /> Address City Zip <br /> Phone No.( 1 <br /> c. Describe meth ad to be used for decontamination: <br /> d. Describe haw rinsa[a ma]adat W11 be stored onsile prior to manifesiing offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Hauler Registration# <br /> Address City Zip <br /> Phone No,( ] <br /> Permuted Disposal Site <br /> fi. a. Descrlbe the method Thal will be utilized to purge and/or inert the tank(s): vac truck <br /> b. TanklPlping Hauler: <br /> Name N/A <br /> Address City Zip_ <br /> Phone Na-{ y <br /> Hauler Registration#(if hauled as hazardous) <br /> 4of10 <br />