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1 <br /> i (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? <br /> (b) Is the current certificate of worker's compensation insurance on file? YES ND[I <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification-? YE3 J NO[] <br /> (d) Has everyone on site,Including crane/backboe operator,been certified YES NO[] <br /> to work on hazardous waste Site In accordance with CCR Title 8? <br /> YESX NO() <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? <br /> YEsyq; NO[) <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation permit.? <br /> NIA19 YES l I NO[] If YES, Permit N <br /> 4. Has(the contractor obtained approval from the local fire department to perform tank NM cutting?g YES[ NO[ <br /> 5. Is there knowledge or evidence of leakage from the tanks)and/or piping? Of yes,please explain)YES[J NO <br /> {e{ <br /> 6. It tank residual exists,Identify transporting hazardous waste hauler <br /> I a <br /> Nam6-4'rUe�J/�',v 'r/Ip/hr;'ir <br /> OO ��"�� ��ulerReglstratlon/ <br /> iAddress1J g SS is ah,�{,- T.�Y}� � Cl P 7 <br /> Phone N( Rro(�) y—a� <br /> I7. Decontamination Procedures: <br /> f a. Will tank(s)and piping be decontaminated prior to removal? <br /> PEOC NO[J <br /> i <br /> b. Identify contractor performing decontamination: <br /> jName IA`'/}/�I�� I.��Cii lr�l�nLl/7'/7�9J `c✓ l� L/�/ <br /> Address..__L� Clty�,✓ n...__ <br /> Phone No.( , 2, �1 I'7 Zip <br /> C. Describe ethod to be used for decont bon: <br /> d. Tribe how Hassle matgrl I will be stored 011site prior to manlfes goff te: <br /> t2 <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility. <br /> Hauler Nsm` ,lr'y /�„ �n� / <br /> 1A� hPHaNer Re hatlon t <br /> Address <br /> t Ofty�'rZiQ�,ZfP�a� <br /> Phone No., <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 08/13/99) Page 4 <br />