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(b) Is the current certificate of worker's compensation insurance on file? YES O, NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[ NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> (e) hazardous waste site in accordance with CCR Title 8? YESJW NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES Pb NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/t) L1-_ (] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NW�M[]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] N9 <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name_ "Ae, / x',414£"7 —Hauler Registration#� /J0 <br /> Address F,v �UX .3 7 i9 l/ City D.FeA` l zip <br /> 7 —3 1 <br /> Phone#( 1 ) �t7 7 / V �� B,[ I—eve /2 L X! �s <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES(7� NO[] <br /> b. Identify contractor performing decontamination: tt// <br /> Name254_�/ sof' `U/L /,UG <br /> L <br /> Address F� z7 F, D GK f6-�r d city 6 d V l Zip <br /> Phone No.( <br /> { <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> //4G "C-A- <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler NameA7f/1/Ci¢� 64 t;;j� Hauler Registration# <br /> le,/� 3 <br /> Address 92 4 pY3!?a City ]� £ L/f� Zip C/ -?�3/5,- <br /> Phone No. ( Z © / ) 5S6 7 76 7 J` <br /> Permitted Disposal Site <br /> EH 23046 (Revised 10/16/03) D� f Page4�4f <br />