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1. (a) Is there a PHS-EHD contractor's and subcontractors questionnaire on Ne or enclosed? YES[j N0;(j (b) Is the current certificate of worker's compensation Insurance on Ne? YES P9 NO[I (c) Does the contractor possess a"Haurdous Substance Removal certification"? YES P,7 N_0 I I (d) Has everyone on site,Including cranelbackhoe operator,been certified to work on hazardous waste site In accordance with CCR Title 87 YES[q NO I j 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES Kj NO[) 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Rxeavation Permlt'? NIAJg YES I I NO[I If YES, Permit R 4. Has the contractor obtained approval from the local fire department to perform tank cutting7 NA[j YES[I NOW 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? of yes,please explain)YES I I NOIJ 6. It tank residual exists,Identify transporting hazardous waste hauler. Name E.C.I. Halder Registration/ 0019 Address 255 PARR BLVD. city RICHMOND Zip 94801 Phone#( 510 ) 235-1393 7. DecontaminationProcedures: a a- Will tank(s)and piping be decontaminated prior to removal? YES11'NO W TANKS WILL BE BUT NOT PIPING. THEY WILL BE PLACED IN BIN PROVIDED BY ECI AND DISPOSED OF b. Identify contractor performing decontamination: UNDER MANIFEST AT THEIR FACILITY. Name E.C.I. Address 255 PARR BLVD. City, RICHMOND zip 94801 Phone No{ 310 ) 235-1393 C. Describe method to be used for decontamination: PRESSURE WASHED, TRIPLE RINSED AND DRY ICE i d. Describe how rinsate material will be stored onsite prior to manifesting offsite: PUMPED INTO TANKER PROVIDED BY E.C.I. e. Rhtsate Hauler and permitted Treatment,Storage&Disposal Faculty: Hauler Name E.C.I. Harder Registration 1 0019 Address 255 PARR BLVD. City RICHMOND Zip 94801 Phone No.( 510 ) 235-1393 Permitted Disposal Site ROMIC i IEH 23 046 (Revised 08/13199) Page 4