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SAN JOA U1 <br />---COUNTY----- <br />Environmental Health Department <br />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. Hasa "Site Health &Safety Plan" for this job site been submitted? YES [X ] NO [ ] <br />3. Has <br />applicant performing <br />removal <br />in the City of <br />Tracy obtained a "Grading and Excavation Permit"? <br />N/A <br />[X ] YES [I <br />NO [ ] <br />If YES, <br />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 [ ] <br />NO KNOWLEDGE OF LEAKING FROM TANK. TANK DISCOVERED DURING REDEVELOPMENT, <br />6. <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name EnviroGuard <br />Hauler Registration #4'050 <br />Address 2348 Cebu Court city Placentia <br />92870 <br />Phone # ( 714 52&2510 <br />Decontamination Procedures: <br />zip <br />a. Will tanks) and piping be decontaminated prior to removal? YES [X ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name RB ENVIRONMENTAL, INC. <br />Address 4460 HWY 99 FRONTAGE ROAD City STOCKTON Zip 95215 <br />Phone No.( 209 ) 932-0606 <br />c. Describe method to be used for decontamination: <br />ANY NlnnelNlnl I QUID 4111 1 RF REMOVED AND PI ACED INTO DRUMS F10R DISPOSAL <br />TANK %nnl L RE TRIPLE -RINSED WTIH CL€ANING AG€NT <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />RINSE MATERIAL WILL BE PLACED INTO DOT DRUMS AND STORED ONSITE PENDING DISPSOAL. <br />e. Rinsate Hauler and permitted Treatment, Storage &Disposal Facility: <br />Hauler Name EnviroGuard <br />Hauler Registration # 4050 <br />Address 2348 Cebu Court city Placentia <br />Zip <br />Phone No. (714 526-210 <br />Permitted Disposal Site , 234 E. 13th Street, Yuma, AZ <br />Describe the method that will be utilized to purge and/or inert the tank(s): <br />15 lbs of DRY ICE PER 500 GALLON TANK VOLUME WILL BE USED TO INERT TANK <br />b. Tank/Piping Hauler: <br />RB ENVIRONMENTAL <br />Address 4460 HWY 99 FRONTAGE ROAD City STOCKTON <br />Zip <br />92870 <br />95215 <br />Phone No.(209 ) 932-0606 <br />Hauler Registration # (if hauled as hazardous) NA -TANK WILL BE NON-HAZ 3946 <br />4of10 <br />