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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[T NO[] <br /> (b) is the current certificate of worker's compensation insurance on file? YES[T NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certlfication"? YES[T NO[] <br /> (d) Has everyone on site,including cranefbackhoe 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 Job site been submitted? YES[ NO[J <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[T, YES[] NO[] if YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NADA YES[)NO[1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[J NO[$ <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name N/A Hauler Registration# <br /> Address City Zip <br /> Phone N( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES� NO[] <br /> b. Identify contraetor performing decontamination: <br /> Name Jim Thorpe 0I1, Inc. <br /> Address P.O. Box 357 City Lodi Zip 95241-0357 <br /> PhoneN04 209 ) 368-6175 <br /> C. Describe method to be used for decontamination: <br /> Lines were triple rinsed prior to tank removalin early 1999. <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> N/A <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name N/A Hauler Registration# <br /> Address City Zlp <br /> Phone No. ) <br /> Permitted Disposal Site N/A <br /> EH 23 046 (Revised 10119198) Page 4 <br />