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1. (a) Is there a PIIS-EIID contractor's questionnaire on Ole or enclosed? YES kj NO I I (b) Is the current certificate of worker's compensation Insurance on Ne? YES NO I j (c) (toes the contractor possess a Hazardous Substance Removal Cerliflatioo"? YES NO I I (d) Das everyone on site, Including crone/backhoe operator, been certified to work on hazardous waste site In accordance with CCR Title 87 YES NO 11 2. Iles a "Site Health & Safety Plan" for this job site been submitted? YES NO I 3. fins ap Ilant performing removal In the City of "Tracy obtained a "Grading mod Excavation Permit"? N/A YES I I NO I if YES, Permit N upon approval 4. tins the contractor obtained approval from the local Ore department to perform tank culling? NAI I YESI I NON S. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES I I NON 6. If lank residual eslsts, Identify transporting hazardous waste hauler: Name Nor Cal Waste Oil Haulers hauler Registration N CAD 982417255 Address P. 0. Box 645 _ City Denair, CA Zip 95316 Phone 8( 800 I 332-8710 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES DQ NO I I b. Identify contractor performing decontamination: Name Jim Thorpe Oil, Inc. Address P. 0. Box 357 City Lodi Zip 95241-0357 Phone No.( 209 ) 368-6175 C. Describe method to he used for decontamination: Tank(s) and piping will be triple rinsed with a biodegradable soap solution d. Describe how rinsole material will be stored onsite prior to manifesting offsite: le on site until they can be removed to a proper disposal facility. e. Rlnsate Ilauler and permitted Treatment, Storage h Disposal Facility: Hinder Name same as N6 Hauler Registration N— Address City Zip Phone No. I Permitted Disposal site Americlean, Inc. 2570 Almond Dr., Silver Springs, NV 89429 5/20 Ell 23 046 (Revised 9/11/96) Page 4