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1. (a) Is there a PHS MID contractor's and subcontractor's questionnaire on file or enclosed? YES p( NO{] <br /> (b) is the current certificate of worker's compensation Insurance on file? YESRq NO[) <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES y( NO[ <br /> (d) Has everyone on site,including crane/backhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES No[I <br /> 2. Has a"site Health&Safety Plan"for this Job site been submitted? YES NO]I <br /> S. Has applicant performing removal In the City of Tracy obtained it"Grating and Excavation Permit"? <br /> NIA K YES[I NO[I If YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N.4p(YES[I NOR( <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? Of yes,please explain)YES I] NO <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name 1Q,/ l __�QD t)"A/65 Hauler Registration f <br /> Address .Lw& Li. XD n Q Zt �'Clty KA lip gOo2�8 <br /> J� Phoned <br /> 7. Decontamination Procedures: <br /> S. Will tank(s)and piping be decontaminated prior to removal? YES K NO[] <br /> b. identify contractor performing decontamination: <br /> Name rn 5 �EQ/Jil'��Sn/ <br /> Address--V,06 Z�. A lD NG✓2A CNfYI City—4�,Qiw4 71p QD.�2 Y <br /> i <br /> Phone h'o.&iD J-6.2 3 'ti43D <br /> C. Describe method to be used for decontamination: <br /> d. Describe how riusate material will be stored onsite prior to manifesting offsite: <br /> Kti-gL �R�r l5 _ <br /> E r.�t lc.s <br /> e. Rfusate Hauler and permitted Treatment,Storage&Disposal racWty. <br /> HaulerName��[[ pm/S _// erzliC/f 5 HaWarRegistration 0 <br /> Address_ ,05 Cltyg d Aw MI) <br /> EH23046 (Revtsed UAllJI9'i) Page❑ <br />