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• <br />1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on Ole or enclosed? YES kj NO (] <br />(b) is the current certificate of worker's compensation insurance on tile? YES ( NO [ <br />(c) Does the contractor possess a "Hazardous Substance Removal CertlOcation"1 YES [¢ NO [ [ <br />(d) Has everyone on site, Including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accord Mee with CCR Title 8? YES'[{} NO ( ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES t4 Noll <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permlt"1 <br />NIA YES (] NO [ j It YES, Permit M <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA61ES( J NO( ] <br />5. Is there knowledge or evidence of leakage Irom the tank(s) and/or piping? (If yes, please explain) YES (J NO _ <br />6. If tank residual exists, Identify transporting hazardous waste hauler. <br />I <br />Name 7AtS <br />Hauler Registration M <br />arldraca City Zip -- <br />Phone M ( ) <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontardnated prior to removal? YES r] Noll <br />b. Identify contractor performing decr,ntamination: <br />Name JIM HOBLITZELL <br />Address BOX 30331 CytySTOCKTON,CA ZD 95213 <br />Phone No! 209 I 943 7793 <br />c. Describe method to be used for decontamination: <br />USING HIGH PRESSURE WATER, ADD'_NON CHLORINATED CLEANER AND WASH AND <br />REE CYCLES. AT EACH INTERVAL EVACUATE <br />VACUUM TRUCK FOR OFF HAUL AND DISPOSAL UNDER MANIF. <br />d. Describe how rinsate material will t e stored onsite prior to manifesting offsite: <br />IT WILL NOT. EVACUATE RINSEATE INTO VACUUM TRUCK. <br />e. Rinsate Hauler and permitted Tres. ment, Storage & Disposal Facility: <br />Hauler Name NOR CAL OIL Hauler ReglstraCon N 2 412 <br />Address BOX 645 City DENAIR,CA _ZI 95316 <br />PhoneNo.( 800 ) 332 8710 <br />Permitted Disposal Site <br />EH 23 046 (Revised 10119198) Page 4 <br />