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1. (a) Is there a PH&ERD contractor's and subcontractor's questionnaire on file or enclosed? <br /> (b) Is the current certlflcate of worker's compensation insurance on file? YES�d NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal n fileCertlfcation"1 YES Al NO[] <br /> (d) Has everyone on site,including cmuelbackhoe operator,been certified YESJ j NO(J <br /> to work on hazardous Waste site In accordance with CCR Title 87 <br /> YES V NO(( <br /> 2. Has a "Site Health&Safety Plan" for this Job site been submitted? <br /> YES W NO(J <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA(J YES(] NO[J If YES, Permit Y Al1L� <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[)YES[J NO[J <br /> 5. Is there knowledge or evidence of leakage from the tanks)and/or piping? (It yes,please explain)YES(J NO(� <br /> 6. If tank residual exists.Identity transporting hazardous waste hauler. <br /> Name r i Y,S-,ox I Hauler Reglstration 0 <br /> Address T.l 75�n�?it 1 1 J City .LL l[gV7Zip qg9jej <br /> PhoneN(�1L' <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YES,(J NO[J <br /> b. Identify contractor performing decontamination: <br /> Name CJ._ r'( <br /> Address �iJ. 1�GZ�r 'ei� Ud City e hu0s te4 Up <br /> Phone RoJ5I n 1 :�k 3 r�- I SI-1 <br /> C. Describe method to be used for decontamiWal_: <br /> "t LKS <br /> 614 <br /> d. Describe hour tim_^ate material will be stored onsite prior to mantkesdog ottalte: <br /> e. Musts Hauler and permitted Treatment,Storage&Disposal FacWty: <br /> Hauler NameC J— .:i0 ti/ Hauler Registration N 1 3. <br /> Address �Z`3 j ' t')IRI ,A ey([.'G� city �4�c stn lfm Zip C. 7 <br /> r <br /> Phoue No.( � lam' <br /> Permitted Disposal Site 3.7s7 <br /> EH 23 046 (Revised 10119198) Page 4 <br />