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(b) Is the current certificate of worker's compensation insurance on file? YES X NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESX 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? YEsK NO[] <br /> 2. Has a"Site Health&r Safety Plan"for this job site been submitted?A7-)(fAed YESK NO[] <br /> 3. Has applicant performing removal in the City of 'obtained a"Gradin i and Excava bn Permit"� <br /> N/A[] YES I] NO[] If YES, Permit# �" ^' �r p <br /> ©C <br /> 4. Has the contractor obtained approval from the local fire department to perform tank culdrV? A�K YES[j NO[] <br /> N" C <br /> 5. Is there knowledge r evidence of leakage from tl�e tank (,Ifs)and/or piping? es,please explain)YES[] NO� <br /> I/ <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Hauler Registra 'on#� C P 7-3 <br /> 5 '�-I'J`" Ci B l� <br /> Address ty I�`1 Zip <br /> Phone#( 5 j 0 } .� <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESK NO[] <br /> b. Identify contractor performing decontamination: <br /> Name c J' <br /> Address it I V City i-e helle f Zip 1 tkOq' <br /> Phone No. 510 <br /> C. Describe method to be used for deco,,I�tgunination: <br /> Tr ;p K N7 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitter)Treatment,Storage&Disposal Facility: <br /> Hauler Name C Hauler Registration# <br /> Address_ r "Od City K r Xl Zip I <br /> Phone No.( v) <br /> Permitted Disposal Site__-90M ! C� <br /> EH 23 046 (Revised 10/16/03) Page 4 <br />