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SA N 10 A Q U I N Environmental Health Department <br /> -- COUNTY --- <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. Has a "Site Health & Safety Plan" for this job site been submitted? YES [X ] NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [X] YES [I 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 tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br /> NO KNOWLEDGE OF LEAKING FROM TANK. TANK DISCOVERED DURING REDEVELOPMENT. <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name EnvlroGuard Hauler Registration #4050 <br /> Address 2348 Cebu Court city Placentia Zip 92870 <br /> Phone # ( 714 ) 526-2510 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [X ] NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name RB ENVIRONMENTAL, INC. <br /> Address 4460 HWY 99 FRONTAGE ROAD City STOCKTON Zip 95215 <br /> Phone No.( 209 ) 932-0606 <br /> C. Describe method to be used for decontamination: <br /> ANY nlnnelnlnl I QUID 4111 1 BE REMOVED AND PI ACED INTO DRUMS F=OR DISPOSAL <br /> TANK %4111 L RE TRIPLE-RINSED WTIH CL€ANING AGE NIT <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> RINSE MATERIAL WILL BE PLACED INTO DOT DRUMS AND STORED ONSITE PENDING DISPSOAL. <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name EnvlroGuard Hauler Registration # 4050 <br /> Address 2348 Cebu Court City Placentia Zip 92870 <br /> Phone No. ( 714 526-2�110 <br /> Permitted Disposal Site �` Sydcol LLC, 234 E. 13th Street, Yuma, AZ <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> 15 Ibs of DRY ICE PER 500 GALLON TANK VOLUME WILL BE USED TO INERT TANK <br /> b. Tank/Piping Hauler: <br /> Name RB ENVIRONMENTAL <br /> Address 4460 HWY 99 FRONTAGE ROAD City STOCKTON Zip 95215 <br /> Phone No.(209 ) 932-0606 <br /> Hauler Registration # (if hauled as hazardous) NA - TANK WILL BE NON-HAZ 3946 <br /> 4of10 <br />