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1. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES [* NO [ [ <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [)I NO [ I <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES 14 NO I [ <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 1A NO [ 1 <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [A NO [ I <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A 1)9 YES I I NO I I If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NARI YES[ I NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ J NO [}d <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: (See attached sheet for <br /> additional haulers) <br /> Name Ramos Environmental Service Hauler Registration # 0518 <br /> Address 1515 S. River Rd. CityWest SacramentcZip 95691 <br /> Phone # ( 916 ) 371-5747 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YESJ)J NO [ I <br /> b. Identify contractor performing decontamination: <br /> Name OGISO Environmental <br /> Address 1504 Franklin Street City Oakland Zip 94612 <br /> Phone No.( 510 ) 451-5771 <br /> C. Describe method to be used for decontamination: <br /> Steam cleanin with , steam leaner <br /> e, ,;_ Z,1.r..�,e G <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinsate will be stored onsite in Baker tank prior to being offhauled <br /> in vacuum truck <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Universal Environmental Hauler Registration # 3240 <br /> Address 1898 Park Road City Benicia Zip 94510 <br /> Phone No. ( 707 ) 747-6699 <br /> Permitted Disposal Site Seaport, 675 Seaport Blvd. , Redwood Cita, CA 94063 <br /> 5/20 <br /> EH 23 046 (Revised 9/11/96) Page 4 <br />