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(b) Is the current certificate of worker's compensation insurance on file? YES% NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES M 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 K NO[] <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# W& <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAQQ YES[]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO pq <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: 2s�CtiAt -P►►acED DoT O Coo 503fl S�49�►s <br /> 11.�[b WI+.ST Q�Ir T�tp1� pSL VkC4-01? FOR- . 'DISC.#Z4Z <br /> Hauler Registration#LAkp4 C_A Z5Ca5'T 8 <br /> • Address. CoBSb �M\'c1't, +.y�r,�riu� City NF_y.�AQtL Zip 94SCDO _ <br /> Phone# 19 5—44 O O <br /> 7, Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES K NO j] <br /> b. Identify contractor performing decontamination: <br /> Name JaWb .?1Sa A,hii c A,j— C . <br /> Address 7-C600 W t LLl AM 5 ST. City SP*a LkAmmnzip 94 s o n <br /> Phone No.( 51 C )_(1 A -_8 39 O X M1 <br /> 1 <br /> C. Describe method to be used for decontamination: <br /> E� y.t2,� wA.srl i1St�i� �l~TERt�\-�/w A'tEQ Mix.'T2iP��2i�1gE. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> _ D__%t1 5S C,, + L. nVa.UI'As tfA 1•-LA-f--• WASME STnk1aGE b.V_!FA <br /> _Etz 2kcvL-Q9 MN VkN%; \N STC " M1uL e01y"..C,1Q4r-� as PAI s1 . <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name _ L1 P jRF_MEfl,!kflauler Registration# Z1Caz8I <br /> Address. S tri 715 L1_AG A5 Alf E . __City So"T 1.t M&Z:ln N Zip 9 5 cti 4 CO <br /> Phone No. (40A )_(o 83 044'7 <br /> Permitted Disposal Site G ALCM L'Tp. <br /> EH 23 046 (Revisedl0/16/03) Page 4 <br />