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4 of 10 <br />Environmental Health Department <br />1. (a) Is the current certificate of worker's compensation insurance on file?YES [ ] NO [ ] <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [ ] NO [ ] <br />(c) Has everyone on site, including crane/backhoe operator, been certified to work on YES [ ] 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 [ ] <br />____________________________________________________________________________________________ <br />____________________________________________________________________________________________ <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name________________________________________________ Hauler Registration #_____________ <br />Address________________________________________ City_________________ Zip______________ <br />Phone # (__________)__________________________________________________________________ <br />7.Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal?YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name _______________________________________________________________________________ <br />Address _______________________________________ City _________________ Zip ______________ <br />Phone No.(__________)_________________________________________________________________ <br />c. Describe method to be used for decontamination: <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name_________________________________________ Hauler Registration #______________ <br />Address________________________________________ City _________________ Zip______________ <br />Phone No. (__________)________________________________________________________________ <br />Permitted Disposal Site__________________________________________________________________ <br />8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br />_______________________________________________________________________________________ <br />_______________________________________________________________________________________ <br />b.Tank/Piping Hauler: <br />Name__________________________________________________________________________________ <br />Address________________________________________ City________________ Zip _________________ <br />Phone No.(__________)____________________________________________________________________ <br />Hauler Registration # (if hauled as hazardous)__________________________________________________ <br />Innovative Construction Solutions <br />2525 Stanwell Drive, Suite 200 Concord 94520 <br />Containerized in totes. <br />Drain and rinse fuel lines back to the USTs (gravity flow), tripe rinsing of the UST interor and pipelines, collect rinseate fluids in totes for characterization and offhaul, cut windows into UST for additional cleaning, inert with dry ice at a rate of 2 lbs per 100 GAL of tankage. <br />Drain and rinse fuel lines back to the USTs (gravity flow), tripe rinsing of the UST interor and pipelines, collect rinseate fluids in totes for characterization and offhaul, cut windows into UST for additional cleaning, inert with dry ice at a rate of 2 lbs per 100 GAL of tankage. <br />925 574-2600 <br />We will work with the fire department before permit issuance. <br />ECTI 3731 <br />953 W Reece St San Bernardino 92411 <br />800 664-7773 <br />ECTI 3731 <br />953 W Reece St San Bernardino 92411 <br />800 664-7773 <br />World Oil Recycling, Compton, CA <br />ECTI <br />7275 National Dr, Suite C Livermore 94550 <br />800 664-7773 <br />060424550498GI