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1. (a) Is there a PHS•EHD contractor's and subcontractors questionnaire an file or enclosed? YES NO[] <br /> (b) Is the current certificate of worker's compensatian insurance on file? YES 1 NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Cerdflcation"? YES]j NO(] <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 11 <br /> Z Has a"Site Health 3c Safety Plan"for this job site been submitted7 YESId NO[] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting". NAUYES(]NO[1 <br /> 6. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[] NOX <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name NorCal Waste Oil Haulers Hauler Registration 4 CAD 982417255 <br /> Address P•0. Box 645 City Denair ,, CA 71p 95316 <br /> Phone#( 800 ] 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[T NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc . <br /> Address P.O. Box 357 City Lodi , CA Zip 95240 <br /> PhoneNo4 209 ] 368-6175 <br /> C. Describe method to be used for decontamination: <br /> Tank( s ) and piping will be triple rinsed with a_ biodearadeable <br /> soap solution and hot wter. <br /> d. Describe how rinsate material will be stared onsite prior to manifesting offsite: <br /> The rinsate will be removed from the tank( s ) as it is hein- <br /> delivered to the opposite end of the tank. <br /> e. Rlnsate Hauler and permitted Treatment,Storage&.Disposal Facility: <br /> Hauler Name Same as 6 Hauler Registration.# <br /> Address city ZIP <br /> Phone No.( ) <br /> Permitted Disposal Site 9mericIeari n 9370 Almond Tlr �c i - c rings , Nv • <br /> or other approved facility . <br /> EH M 046 (Revised 10119198) Page 4 <br />