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(b) Is the current certificate of worker's compensation insurance on file? YES14 NO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESA 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? YES . NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES[] NO$d <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A [I YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[D]YES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO j(] <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name AfM tr%c.c.s. W(ey W&s E - © , Hauler Registration# 37yy <br /> Address ?0 l3 0 r 3` I O City 1b l 1,. Zip 9S 119 <br /> Phone#( SS00 ) 73Z `1(*ys <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESIK], NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Cy-ptUO.+.ceJ I�CoGnu ro. r.c �.1 <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> *ensure R:.mSc w;} t, <br /> d. Describe how rinsate material will be stored onsiteprioto manifesting offsite: <br /> r <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name tt Mer(c m f� V k l fcy W ks�e Hauler Registration# 3 7`f`l <br /> Address City Zip <br /> Phone No. ( ) + <br /> Permitted Disposal Site ��u 17Ar�� O - <br /> A T t-an s Pa- <br /> EH 23 046 (RevisedIO/16/03) Page 4 <br />