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1. (a) Is the current certificate of worker's compensation insurance on file? YES[W NO [] <br /> (b) Does the contractor possess a "Ha<ardous Substance Removal Certification"? YES 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 NO [] <br /> 2. Has a "Site Health & Safety Plan"for this job site been submitted? YES PQ NO [] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA [] YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval fi-om the local fire department to perform tank cutting? NA[])TS[ ] NO[] <br /> b. Is there knowledge or eviclence of leakage from the tank(s) andior piping? (If yes, please explain)YES NO [] <br /> f4YIN, PrIIJIA r 54Q-P, <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name f,Aaiy-,5 t ---// Hauler Registration# <br /> Address �1( 8-\nn�Cco, ���� City U"c� &c\6 — Zip <br /> Phone#( ) "Q_3" L) -- <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) iug be decontaminated prior to removal? YES 14 NO [] <br /> b. Identify contractor performing decontamination: <br /> Name_i, - �3cx ryl S � r oicz.<, �✓�G <br /> Address t-1 J_�L, PrlQ)j &O% b\ .7c� City Cir Er1a zip coaLi <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> Tai\Yn,;e tee U;IltSf•E'd <br /> d. Describe how rinsat material will be stored ons'te prior to manifesting offsite: <br /> rr nca Ae i)r t 1 �f lXcc..ul.k r�CI ,j\� ;iw^ -�' et <br /> til;s�r�cLx.r -f�t.c_,1•t,s Scan•.e. ,n c, <br /> e. Rinsate Hauler and permitted Treatment, Storage&. Disposal Facility: <br /> Hauler Name As Aare S Se.- i a-s -z,c ---Hauler Registration# 3CjC>`)S <br /> Address wb \p(�/�t�, (3`.,rr� City,-"-r_ Caw zip�(�24� <br /> Phone No. {�I(�) S'2�—`4``k 3r <br /> Permitted Disposal Site P_mf(W�2� 1 K���(�C�'1 2-000 10 4)4rA'Ve/ 4 �} KOPAL) 4 <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> il)iII he '04 1c,&CA Pr,ar 4 <br /> b. Tank/Piping Hauler: <br /> Name 6e-Pg D) I i,, 9,-Y\e,\4- -T't�° ---- <br /> Address � Z ? )�v�(x/' �r' City L1-L'./7yv:2zip GJ �sI <br /> Phone No. l( <br /> Hauler Registration#(if hauled as hazardous) lVQi�ba j 0 <br />