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(b) Is the current certificate of worker's compensation insurance on file? YESN NO [] <br /> c Does the contractor possess a"Hazardous Substance Removal Certification"? YESA NO[] <br /> () Has everyone on site,including crane/backhoe operator,been certified to work on YES NO ] <br /> (e) hazardous waste site in accordance with CCR Title 8? <br /> 2. Hasa"Site Health&Safety flanYES NO <br /> ."for this job site been submitted? [] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/AX YES[] NO t] 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[] NOA <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> �� E-D1rxj�saJ Hauler Registration#— <br /> Name u A, --}� p <br /> Zip_ <br /> �i�Lf 5iE LAT k: City 1 aL— <br /> CT <br /> Address `` <br /> Phone#{ z5 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESA NO [] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address l C— Cite t-, LI zip <br /> Phone No.{ } ) � <br /> C. Describe method to be used for decontamination: <br /> -:4 LK1N_5k _. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> JM5 -- <br /> �X 5-31-C1� <br /> e. Rinsate Hauler and permitted Treatment, +Storage&DisposaI Facility: <br /> Hauler Name <br /> f)W 5©�-J D��'� \ 1}A7TL- Hauler Registration# C) I L0 <br /> II � F �y�, , <br /> Address firs Why <br /> City OMA'If P*D Zip <br /> Phone No. { 0 ) zZ ! <br /> Permitted Disposal Site © � U� 100 <br /> EH 23 046 (Revised 10/16/03) Page 4 <br />