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1. (a) Is there a PAS-EHD contractor's questionnaire on file or enclosed? YES k3 NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on tile? YES k� NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification"' YES kJ NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES JJ NO [ ] <br /> 3. Has applicant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit? <br /> N/A V1 YES [ ] NO [ I If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAFJ YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO ( ] <br /> HAS HAD TEST DRTi TNC'S 7nig C0I lTaMTNzTTIN WITU nrv�;nmTVg RRS;4,' -S (Ne Eenteminetion) <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name ERICKSON TRUCKING Hauler Registration # 69 8 <br /> Address 255 PARR BLVD City RICHMOND Zlp 94801 <br /> Phone # ( 510 ) 235-1393 EPA I.D. rn <br /> L100A-466 29P <br /> 7. Decontamination Procedures <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [)Jx NO [ ] <br /> b. Identify contractor performing decontamination <br /> Name WESTERN METER SERVICE, INC. <br /> Address 2735 TEEPEE DR, STE E, h P STOCKTON Zip 95205 <br /> Phone No.( 209 ) 948-6124 <br /> C. Describe method to be used for decontamination <br /> TANKS AND PIPING WILL BE TRIPLE RINSED WITH A SOLUTION OF DETERGENT <br /> AND WATER. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting oftaitet <br /> IN 55 GALLON DRUMS <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility- <br /> ENVIRONMENTAL SERVICE CAD4400-3556 <br /> Hauler Name Hauler Registration # <br /> Address P.O. BOX 401 pn,WEST SACRANEBTIZip95691 <br /> Phone No. (916 ) 371-2570 <br /> GIBSON OIL AND ]2EFINING CO. , 475 SEAPORT BLVD. , <br /> REDWOM CIT)r, CA <br /> Permitted Disposal Site 94863 (41r)1rR—FS11 <br /> Page 4 <br />