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0 0 1. (a) Is there a PH&EHD contractor's and subcontractor's questionnaire on file or enclosed? (b) Is the current certificate of worker's compensation insurance on tile? (c) Does the contractor possess a "Hazardous Substance Removal Certification"? (d) Has everyone on site, including cranelbackhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES NO(] YES ( NO [ ] Iii l� YES b. NOI] YESTA NO[] 2. Hasa "Site Health & Safety Plan" for this Job site been submitted? YESA NO[] 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? NIA �, YES [ ] NO[] If YES, Permit 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NARUS[ ] NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES [ ] NO Vf-- 6. If tank residual exists, Identify transporting hazardous waste hauler. Name J . 1'r Hauler Registration N M. Phone 7. Decontamination Procedures: a. WW tanks) and piping be decontaminated prior to removal? YES M NO [ ] b. Identity contractor performing decontamination: Name JIM HOBLITZELL Address BOX 30331 City S TOC KTON, CA Zip 95213 Phone N04 209 ) 943 7793 C. Describe method to be used for decontamination: USING HIGH PRESSURE WATER, ADD NON CHLORINATED CLEANER AND WASH EE CYCLES. AT EACH INTERVAL EVACUATE UM TRUCK FOR OFF HAUL AND DISPOSAL UNDER d. Describe how Ansate material will be stored onsite prior to manifesting offsite: IT WILL NOT. EVACUATE RINSEATE INTO VACUUM TRUCK. e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. Hauler Name NOR CAL OIL Hauler Registration# 2412 Address BOX 645 City DENAIR,CA _ZIP 95316 Phone No. ( 800 1 332 8710 Permitted Disposal EH 23 046 (Revised 10119198) Page 4 Gib MANIF