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SANJOAQUINEnvironmental Health Department <br /> ---C OU NTY--- 0 2018. <br /> ENVIRONMENTAL HEALTH <br /> 1 (a) Is the current certificate of worker's D Rpaqsal"Tce on file? NO I <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YESNO' I <br /> (c) Has everyone on site,including crane/backhoe operator,been certified to work on YES;,V NO <br /> hazardous waste sites in accordance with CCR Title 8? <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES X NO <br /> 3. Has p ficant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N YES[] NO[] If YES, Permit <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAI ) YES I I NO Y4. <br /> 6. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (if yes,please explain) YES I I NO�tl <br /> - jW \kl� P ( <br /> 6. If tank residual eyists,Identify tra6m7oortinn-hazar fous waste h uler: 0 JW <br /> YQWV <br /> N <br /> Hauler Registration# <br /> 1> <br /> Address e, UA)A\ cit. ZipXK <br /> Phone <br /> 7. Decontamination Procedures: <br /> a. Wit tank(s)and piping be decontaminated prior to removal? YES[)t NO I <br /> b. Identify contractor performing decontamination: <br /> Name. L-C- S <br /> Address 71&2"1 City FDMKw.,, zip <br /> Phone No. <br /> 0. De cribs thod to bp used for decont rrunation: <br /> d. Descri e how ri sale material will be stored on its pnor to manifesting te: <br /> ta- <br /> . <br /> e. Rinsale Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Hauler Registration# <br /> Address 7 �Cw-41,�eN- city" <br /> Zip lot 0 <br /> Phone No.( I ) "' <br /> s.rz— <br /> Permitted Dispos-1 n:- VNV%C1 <br /> B. CA- <br /> a. Describe the meth that will be utilize t purge a /or inert the tank <br /> SIG& M." <br /> -i <br /> b. I in auler: <br /> Name lflerl- ('04S./ <br /> Address— 0 Zip <br /> Name 'a <br /> u' <br /> P tA*Ae <br /> ,e <br /> fle5- <br /> dd'e.'s <br /> Phone No. L <br /> ' <br /> 7HaulerReglstraflon#(if hauled as hazardous)_ <br /> 4o <br /> ct <br /> VtVICL��,4 Cj+ <br /> LA <br />