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I <br /> 1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnafra on Elle or enclosed? YES NO[J <br /> (b) is the current certificate of worker's compensation insurance on file? YES[ NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES(] 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[) <br /> 2. Has a"Site Health&Safety Plan"for this Jab site been submitted? YES NO(] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA q YES I J NO[J If YES, Permit N .,t.,. <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[q 13S[)NO(J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[J NO r[' <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name HaulerReglatratlon Y <br /> Address_ City Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YES[) NO[.]� <br /> j b. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No.(_� <br /> C. Describe method to be used for decontamination: <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 Hauler Registration f <br /> Address City Zip <br /> Phone No.( ) <br /> I <br /> Permitted Disposal Site <br /> I EH 23 046 (Revised 08113/99) Page 4 <br />