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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YESK NO [ J <br />(b) Is the current certificate of worker's compensation insurance on file? YESX NO [ [ <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YESK NO [ J <br />(d) Has everyone on site, Including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with CCR Title 8? YES)( NO [ J <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YESX NO J ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA <br />0{ YES [ ] NO [ ] If YES, Permit N <br />4. Has the contractor obtained approval from the local Fire department to perform tank cutting? NAhdYES[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tauk(s) andlor piping? Of yes, please explain) YES I ] NIX <br />6. If tank residual exists, Identify transporting hazardous waste hauler. <br />Name Hauler Registration <br />Address 16iy Cil e__15 %5 <br />Biva City_ Zlp c1`/80/ <br />Phone N <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YESX NO[ J <br />b. Identify contractor performing decontamination: <br />Name <br />Address : 7 /� ���G�� City Z zip 1 S 7 6 <br />Phone No.( 0-09 <br />C. Describe method to be used for <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. <br />Hauler Name �// ��✓>n ; •^ /HaNer R/eglstratlo4 GO 6 c� <br />Address /O/`i chis /, ii✓G City �zip <br />Phone No.( <br />EH 23 046 (Revised 08113199) Page 4 <br />