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1. (a) Is the current certificate of workers compensation insurance on file? YES[] NOV <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? YES W NO[] <br />(c) Has everyone on site, including crane/backhoe operator, been certified to work on `� <br />hazardous waste sites in accordance with CCR Title 8? YES m NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ ] NO jf <br />3. Has a plicant performing removal Permit <br />"?NIA <br />in the City of Tracy obtained a "Grading and Excavation Perm"? <br />erl <br />N/A (y� YES [ ] NO If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAV YES[ ] NO[( <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [I( <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name SAF6T ( - 41 -EGA _Hauler Registration# GAcbSZ,oS-C -J <br />Address SOSO S40 %A 362) 1�b City SALI oA Zip 9S3(o$ <br />Phone#(.Z-oma[ ) SHS (nl I <br />7. Decontamination Procedures: <br />a. Will tank(*) and piping be decontaminated prior to removal? YES [) NO [� <br />b. Identify contractor performing decontamination: <br />Name n]ai 11E6es.& FoA, '(NrS 16VA9 [.LoSor[,6 <br />Address <br />City Zip <br />Phone No.( 1 <br />C. Describe method to be used for decontamination: <br />17c1�>' 9n41 <br />d. Describe how rinsate material will be stored ons to prior to manifesting offsite: <br />aoT AP9"Vc& Sc F.ALI.oa hWrAK <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Hauler Registration # <br />City <br />Phone No. <br />Permitted Disposal <br />8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br />b. Tank/Piping Hauler. <br />City Zip <br />Phone <br />Hauler Registration # (if hauled as <br />EH 23 046 (Revised 7/26/2016) q <br />