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1. (a) is there a PH&EHD contractor's and subcontractor's questionnaire on file or enclosed? YES M NO[] <br /> (b) Is the current certificate of worker's compensation Insurance an file? YES M NO[I <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES M No I] <br /> (d) Has everyone on site,Including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 87 YES M NO I] <br /> 2 Has a"Site Health&Safety Plan"for this Job site been submitted? YESg] NO[[ <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA - YES I I NO[] if YES, Permit A <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAUYES(I NO[[ <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES I] NOX <br /> G. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name NorCal Waste Oil Haulers Hauler Registration! CAD 982417255 <br /> Address P.O. Box 643 City Denair , CAy1p 95316 <br /> Phone 9( 800 ) 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES IT NO I I <br /> b. identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc . <br /> Address P.O. Box 357 City Lodi , CA Zip 93240 <br /> PhoneNo.( 209 ) 368-6175 <br /> C. Describe method to be used for decontamination: <br /> Tank( s) and piping will be triple rinsed with a biodetrradeable <br /> soap solution and hot wter. <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> The rinsate will be removed from the tank(s) as it is beinp, <br /> delivered to the opposite end of the tank. <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility <br /> Hauler Name Same as =6 Hauler Rerlstra:lon4 <br /> Address City Zip <br /> Phone No.( ) <br /> Permitted Disposal Site Americ1ean n 2370 Aln,nnrl nr Tc; l�zgr Barings , Nv. <br /> or other approved facility. <br /> EH M 046 (Revised 10119198) Page 4 <br />