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I,, there a PRS-FIID contractor's yneltionnalre on Ole or enclosed? YES Q4 NO I I <br /> (b) Is the current cerilricale of worker's compensation Insurance on Ole? YES NO ( i <br /> (c) Does the contractor possess a ,FIxrardnns SnMlance Removal CerNRcallo's"? YES QQ NO 1 1 <br /> (d) 11,11 everyone on slle, including cr,1ne/bockhoe operator, been certified YES NO <br /> to wank on harardone waste site in accordance with CCR lltle 8? I 1 <br /> t. Ilan n ,Site Itealih A Safely Plan" for this Job site been nrbmllled? YES p NO ( I <br /> 3. IIn1 nnpllrant performing removal in (lie City of l'racy ohiained a "Grading and ExovotiR Permit's <br /> N/A YF.S)Q NO 1 I If YES, Peart N V <br /> .1. Ila1 lite cnnh,1clor obinined npprnv,1l from the local Ore department to perform lank cutting? NAN YESI I NO[ I <br /> 5. Is lltete knowledge nu evidence of leakage from the Innk(s) and/or piping? (If yes, please @spiel's) YES ( I NOD( <br /> fr. If 1,1nk relldltal esists, identify Iranspntting hararrfous waste hauler: <br /> Name fJor—Cal Waste Oil Haulers lfanler Registrations M ('ADg89417955 <br /> Address P.O. Dox 645 City Dena ir, GA zip O9'416 <br /> 800 332-13710 <br /> Phone N ( ) <br /> 7, Decontamination Prncelnrrs: <br /> 11. Will tanks) and piping be decontaminated prior In removal? YES j+t1 NO 11 <br /> JGG C <br /> b. Identify contractor performing decontamination: <br /> Name Jim 'Thorpe Oil, 111C. <br /> Address 1'.O. llox 357 City Lodi, CA Zip 95 47 1_0357 <br /> toy 368-6175 <br /> Phone No.( ) <br /> c. Describe methotl to he used for decontamination: <br /> Triple rinse with hot water and biodegradeable soap solution. <br /> d. Ileperibe how rinsate material will be stored onsi(e pprior 10 manifesting offsite: <br /> Rlneate will be pumped directly from the tank into the waste hauler vehicle <br /> _QF_pU j)e(l inn barrels and crura <br /> e. Rinsme flouter and permitted 1're,1lment, Storage h Disposal Facility: <br /> Ilanfer Name .game as #6 11anler Registration >K <br /> Address City Zip <br /> Phone No. (_ � <br /> 11e( iner•y Services, Patterson, C!1 or other approved facility. <br /> Perml(ted Disposal Site <br /> 5/20 <br /> FII 23 0.16 (Revised 9111/96) page d <br />