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I 1 <br /> Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES [ 1 NONO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? <br /> YES [(c) Does the contractor possess a "Hazardous Subst'nce Removal CertiYES [ ] <br /> NO <br /> fication"? YES [ ] NO [ ] <br /> (d) Has everyone on site, including crane/backhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES [ ] NO 11 <br /> Has a .,Site Health & Safety Plao" for this job site been submitted? <br /> 3, Has applicant performing removal in the City of Tracy obtained a "Grading and Ezcavation Permit"? <br /> YES [ I NO i 1 If YES, Permit # <br /> N/A [ 1 YES] 1 <br /> q, Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] NO( <br /> 5. g g <br /> Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ I NO 11 <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: don <br /> Hayler Registry <br /> Name p— <br /> City�— <br /> Zi <br /> Address <br /> Phone # <br /> 7. Decontamination Proadores: YES I 1 NO I ] <br /> a Will tank(s) and piping be decontaminated prior to removal? <br /> b. Identify contractor performing decontamination: <br /> Name —_ <br /> City ��Zip <br /> Address <br /> Phone No.(_� <br /> Describe method to be used for decontamination: <br /> C. <br /> d, Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> I'1 S �'P ill by I m��r <br /> 16Lq� �j <br /> e, Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hank* Registration #� <br /> Hauler Name <br /> City <br /> Address <br /> Phone No. ( <br /> Permitted Disposal Site 5/20 <br /> EH 23 O46 (Revised 9/11/96) <br /> Page 9 <br />