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IN REDEnvironmental Health Department <br /> SANJOAQU - D <br /> -COUNTY--- <br /> 0C [ 111 0 2018 <br /> 1. (a) Is the current certificate of worker's compensation insurance on file? YE 11 NO f I <br /> I, oval Certification"? NO[ I <br /> mpp I�t "e <br /> (b) Does the con q acAr;p YE Ni <br /> (c) Has everyone <br /> certified to work on <br /> a site,In n ac YES P4 NO[ ] <br /> C AT4" a <br /> hazardous waste sitesRMA A itle 8? <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES X NO <br /> 3. Hasficant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA 9 YES I I NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform lank cutting?NAI I YES I NOY4. <br /> 5. Is there knowledge or evidence of leakage from the lank(s)and/or piping? (if yes,please explain) YES NO <br /> sjonnin -TW,4 0(\A4, r) ( ,(A 6v- <br /> 6. If tank residual e Isis,Identify tran azarflous,waste hauler: qV0,k L$j I <br /> VW-, %d9 <br /> N Hauler Registration <br /> Address <br /> City @,_�Zi <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a, Will lank(s)and piping be decontaminated prior to removal? YES[)L NO I <br /> b. Identify contractor performing decontamination: <br /> Name. L-e- <br /> Address city- Fcmxta zip_.qLj,7Z;Z_ <br /> Phone No. 1130 <br /> C. De cribs rpethod to 4 used for decongtmination: I <br /> d. Descri a ow r safe material will be stored on its prior to manifesting lle.- <br /> 12171gigg- Z;�Jjv ift /qFV*V!rr 4P c!e� /W1W <br /> ld- <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name &kAJL�40= i6u*`o�g"I Hauler Registration# CAVUSIOM2-34tt7 <br /> Address 7,7-1-7 1 'j'_0L.,4,e (w,4r4 Ae city 4Ak Zip 077WO <br /> Phone No.( 9 9700 <br /> Ir- <br /> Permitted Dispos I Site -)CMeV\V%4h 4P4030 VN 6TG fi O <br /> B. a. Describe the melhoo that will e atilizecisc <br /> Mmu <br /> -7 and/or inert the tan <br /> I L <br /> Is— fizz- <br /> b. Ta I in <br /> au <br /> le/r: <br /> Name <br /> Address <br /> City Zip <br /> Phone No.( <br /> Hauler Registration#(if hauled as hazardous) CA -1 <br /> wuzcs-A le 4o <br /> C,+ Tz� 'M <br /> CC) <br />