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2. <br />3. <br />4. <br />5. <br />1 <br />(a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation insurance on file? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(d) Has everyone on site, including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />Has a "Site Health & Safety Plan" for this job site been submitted? <br />YES Ii.t- NO I I <br />YES Iti' NO I I <br />YES NO I I <br />YES I6K NO I I <br />YES j K NO I I <br />Haslicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />ap <br />N/A j,� YES I I NO I I If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA(,I( YESI I NO[ I <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES I I NO It� <br />If tank residual exists, identify transporting hazardous waste hauler: <br />`_ 3/�S <br />Name l �/Y` Hauler Registration # <br />Address 9s0 9rs��% <br />/7V -e.— <br />City X61, -USS <br />Zip 95'03,5 - <br />a-3..5Phone <br />Phone # ( yr�� ) Q4 a <br />- �9Ss <br />(cn�nc) � so;v <br />L)P—e Dee ke <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES I -f' NO I I <br />b. Identify contractor performing decontamination: <br />Name W ty-k <br />Address S Awee ; Ave City M tI�tf4S Zip 9 Sam <br />Phone No.( 4/06 ) 9 t4 -z— 99 S S <br />C. Describe method to be used for decontamination: <br />Flu Sk. -1-k, A.A o. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />.v aa.r,-i e.sl fd y�Q oey 7 VP k -riu- <br />e. <br />Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Registration # .3 1 % S <br />Hauler Name 1 tv <br />Address 9 SU A wt-aS �p City Zip 2S-035 <br />Phone No.( 4r -C ) 7q2-- 5 - <br />Permitted <br />Permitted Disposal <br />5/20 <br />EH 23 046 (Revised 9/11/96) Page 4 <br />/S j)C5 <br />