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1. (a) Is there a PHS•EHD contractor's and subcontractors questionnaire on file or enclosed? Yn NO[I <br /> (b) Is the car.ant certificate of worker's compensation insurance on file? YES zj NO[] <br /> (c) Does the contractor possess a'Hazardous Substance Removal Cartifleatlon'? YES]j NO(] <br /> (d) Has everyone on site,including craneibackhoe operator,been certified <br /> to work on hn-nrdous waste site In accordance with CCR Tltie S? YES NO[] <br /> 2. Has a"Site Health bo Safety Man' for this;ob site been submitted? YESy j NO(j <br /> 3. Has a niicant performing removal ln:he City of Tracy obtained a"Grading and Excavation Permit"? <br /> NI*V- YES(] No[] it YES. Permit.# <br /> 4. Has the contractor obtained approval from the local fire depar:ment to perform tank cutting". IIAt;YES[I NO(j <br /> 5. is thers lmowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES(] NK, <br /> 6. 11 tank residual aysts,ldent.ty transporting hazardous waste Hauler. <br /> Yam. NorCal Waste Oil Haulers Hauler Re;stradon# CAD 982417255 <br /> Address P .O. Bos 643 City Denair, CA Zip 95316 <br /> Phone#( 800 ) 332-8710 <br /> i. Decontaminadon Procedures: <br /> a. WU tankls)and pipL-g be decontaminated prior to removal? YES[x NO[] <br /> b. Identify contractor performing decontaminadon: <br /> Name Jim Thorpe Oil , Inc . <br /> Address P.O. Bos 357 C:ty Lodi , C9 Mp 93230 <br /> P7oneNo: 209 ) 368-6175 <br /> C. Describe method to be used for decontnmLrntian: <br /> Tank( s ) and cipin, will be triple rinsed with a biode—adeable <br /> scan co uz:on and hot ester . <br /> I Describe how rnsata mate:!al will He stared onsite prur to manifesting offsite: <br /> T"_e rinsate will be removed from the tan'k( s ) as it jc <br /> delivered to the opposite end of the tank . <br /> e. Rtnsata 3auler and permitted Treaenent,Starage&Disposal r'ac!lity: <br /> Hauler Name Same as =6 Hauler Rag!st: =lou# <br /> Address Clty ZiP <br /> Phone No.( <br /> Permitted Disuosal Sit- A r T O ;-n m ^rl n c= c i n_= ` • - <br /> ` <br /> cr other apprcyed facility . <br /> E3 9M 046 (Rev!sed 10 IMS) Page 4 <br />