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1. (a) Is then a FES-ED contractor's and subcontractor's questionnaire on file or enclosed? YES NO]] <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES NO(] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certificatlon"7 YES 1Y, NO J] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR TSUe 87 YES NO(J <br /> 2 Has a"Site Health&Safety Plan" for this Job site been submitted? YES JX NO(] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA V YES]] NO l] 11 YES, Permit d <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAWYES{]NO[J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andfor piping? (11 yes,please explain)YES(] NOX <br /> 6. 11 tank residual exists,identify transporting hazardous waste hauler. <br /> Name CQ ,�OIL, <br /> �Hauler Registration C z4rV <br /> Addresn_X,�4 / city � ZIP Do0�f q 2 <br /> Phoned( <br /> 7. Decontamination Procedures: <br /> a. A111 tank(s)and piping be decontaminated prior Lo removal? YES;j NO J J <br /> b. Identify contractor performing decontamination: <br /> Name ADVPAJCi�h C7ECG- V0ZttJM(aJT71t IAJG t <br /> Address K� m - wit,so q f A:q City GTTY� '�J Zip 75zLS <br /> Phone No{ Z!Y'� ) 47—(00 (o <br /> C. Describe method to be used for decontamination: <br /> ..7�IPt-�-21�SE " UrITZ�- STER�� Gt-E7tlJE(L <br /> CL Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> RJdfsA'rE L11t L E� GUu1� 6UT DF aSTs US(k)�j 4 VACilUlvtTRLCK <br /> Ai)n 7Z' AI Dlc?6SF12 f R47 �A-4, F,4e-A L-1 TL)' <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Named N �x (/k I— �j I I 7G} VV <br /> Hauler Registration d <br /> P <br /> Address 0 , FOx I/ <br /> �4�/ // City jp — 2ap �J53f �p <br /> PhoneNo.( Ul ) &&-7 (pb� //�'� /! r _ <br /> Permitted Disposal Site lw u� r1 /t z, 011, 69. (6 1q �� t `i�7L;,C�I <br /> EH M 046 (Revised 10119198) Page 4 <br />