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r (a) Is the current certificate of worker's compensation insurance on file? YESWNOt j <br /> (b) Does the contractor possess a"Hazardowk Substance Removal,Certiflcation"? YESV NO[] <br /> (c) Has everyone on site,including txanelbackhoe operator,been certified to work on <br /> hazardous waste.sites in accordance with CCR Title 8? YES g NO[] <br /> Has a"Site Health&Safety Plan"for this Job site been submitted? YES,K NO(j <br /> 3. Has applicant perforating removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAW YES[I NO[] if YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to,perform tank cutting?NA')(f YES[[ P4011 <br /> S. is there knowledge or evidence of leakage from the tanks)and/or piping? (If yes,please explain)YES[] NO <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: N/A <br /> Name Hauler Reglstradon# <br /> Address C:f typ <br /> r` �i .�i"1 Phone# <br /> 7. Decontamination Procedures; N/A <br /> u� a. Will tanks}and piping be decontaminated prior to removal? YES I j NOW <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No.( } <br /> c: Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsats Hauler and pennitted Treatment,Storage&Disposal Facifity: <br /> Hauler Name Hauler Registration# <br /> Address City Zip <br /> Phone No. D <br /> Permitted Disposal Site <br /> B. a. Describe the method that will be utilized to purge and(or inert the tanks): <br /> r c, VYC* rlR b t-0-5 r <br /> water wi e sent to EBMUD <br /> b. Tank/Piping Hauler. <br /> Name IMPe Services, Inc. <br /> Address <br /> 3400 Manor Street city Bakersfield zip 93308 <br /> Phony No.( 800 458-3036 <br /> x Hauler Registration#(if hauled as hazardous) N/A <br /> a <br /> 131423046 (Revised 8/l/l i) 4 <br />