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SA N J OAQ U N <br /> I Environmental Health Department <br /> -- COUNTY --- <br /> 14 <br /> — COUNTY ----1 . (a) Is the current certificate of worker's compensation insurance on file? YES [x] NO [ ] <br /> (b) Does the contractor possess a " Hazardous Substance Removal Certification" ? YES [x] NO [ ] <br /> (c) Has everyone on site, including crane/backhoe operator, been certified to work on YES [x] 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 applicant performing removal in the City of Tracy obtained a " Grading and Excavation Permit"? <br /> N/A YES [ ] NO [ ] If YES , Permit # <br /> 4 . Has the contractor obtained approval from the local fire department to perform tank cutting? NA[x] YES [ ] NO [ ] <br /> 5 . Is there knowledge or evidence of leakage from the tank(s) and/or piping ? (If yes , please explain) YES [ ] NO [x] <br /> 6 . If tank residual exists , identify transporting hazardous waste hauler: <br /> Name Adams Services Hauler Registration # 3216 <br /> Address 406 E . AlOndra Blvd , City Gardena Zip 90243 <br /> Phone # ( 310 523 -4430 <br /> 7, Decontamination Procedures : <br /> a . Will tank(s) and piping be decontaminated prior to removal ? YES [ ] NON/ When tank Was <br /> b. Identify contractor performing decontamination : discovered it <br /> was clean with 0 <br /> Name LEL and no <br /> Address City Zip piping attached . <br /> With the <br /> Phone No. ( ) condition of the <br /> C, Describe method to be used for decontamination : tank we <br /> recommend that <br /> no cleaning is <br /> performed <br /> d . Describe how rinsate material will be stored onsite prior to manifesting offsite : <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Hauler Registration # <br /> Address City Zip <br /> Phone No. <br /> Permitted Disposal Site <br /> 8 . a . Describe the method that will be utilized to purge and/or inert the tank(s) : <br /> Abandoned tank has no inside contents to purge - 0 LEL <br /> b . Tank/Piping Hauler: <br /> Name Adams Services <br /> Address 406 E . Alondra Blvd . City Gardena Zip 90243 <br /> Phone No. ( 310 523 -4430 <br /> Hauler Registration # (if hauled as hazardous) 3216 <br /> 4of10 <br />