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1. (a) Is then a PH&ERD contractees and subcontractor's questionnaire on file or enclosed? YES _ NO(] <br /> (b) is the current certificate of worker's compensation insurance on Me? No[] <br /> (e) Does the contractor possess a"Hazardous Substance Removal Certification'? NO j] <br /> (d) Ras everyone on site,Including cmnelbackhoe operator,been certified <br /> to worst on hazardous waste site In accordance with CCR Title S? YES d NO[] <br /> Z. Has a'Site Health&Safety Plan' for this job site been submitted? YES,]' NO(] <br /> 3. His"a"p�cant performing removal In the City of Tracy obtained a"Grading and Excavation Permit*? <br /> NTA LY M11 No[] - It= Permit! <br /> 4 Has the contractor obtained approval from the local flte department to perform tank cutting?NA )NO(] <br /> 5. is then knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES j) N01 <br /> Never monitored — unknown <br /> 9. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name Nor Cal Oil Hauler Registration 1982417255 <br /> Address PO Box 645 City yip 95316 <br /> Phoned{ 209 ] 677-6692 <br /> 7. Decontamination Procedures: <br /> a. RTD tank(s)and piping be decontaminated prior to removal? MM NO[] <br /> b_ Identify contractor performing decontaminarion: <br /> Name Advanced GeoEnvironmental/ Nor Cal Oil <br /> Address 4005 North Wilson Way City Stoickton yip 95205 <br /> PhoneNoj 209 ) 467-1006 <br /> C. Describe method to be used for decontamination: <br /> Tri nl a-rima Tankg /Tinea wi h deteraant and wastes Fit 1rgar9 <br /> for dispnsal : haz waste - <br /> d. Describe bow rinsate material will be stored onsite prior to manifesting offsite: <br /> purge waste from lines/tanks for disposal <br /> No on—site storage of waste <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> CAD <br /> HaulerName NorCal Oil — Denair Hauler Registration# 982417255 <br /> Address PO Box 645 Cry Denair yip 95316 <br /> Phone NO.( 209 1 667-6692 <br /> CAD 099425708 <br /> Permitted Disposal Site Industrial Services Oil Co <br /> 1700 S . Soto Street, LosAngles 90023 <br /> EH 23 046 (Revised 10119195) Page 4 <br />