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I <br /> 1. (a) Is there a PHS-9111)contractor's and subcontractor's Questionnaire on file or enclosed? YES)( NO[] <br /> (b) Is the current certificate of worker's compensation Insurance on Me? YEM NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal CardlIcatlon"7 YES NO[1 <br /> (d) Has everyone on site,Including crauelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 87 YESX NO[) <br /> 2. Has a"Site Health&Safety Plan"for this lob site been submitted? YES X NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Parma"? <br /> NIAX YES[I NO[I If YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[J YES[J NOS <br /> 5. is there knowledge or evidence of leakage from the tanks)and/or piping? of yes,please explain)YES[] NOX <br /> S. It tank residual exists,Identify transporting hazardous waste hauler, <br /> Name Ramos Environmental ganfarjgM*X1=jL0518 0 <br /> Address 1515 South River Road Cay West Sacto EV 5691 <br /> Phone R( 916 1 371-5747 <br /> 7. DecontaminationProcedurea: <br /> a. Will tanks)and piping be decontamfnated prior to removal? TBS)( me[] <br /> b. Identify contractor performing decontamination: <br /> Name Ramcon Engineering&Environmental Contracting,Inc. <br /> Address PO Box 1026, OW West Sacto yip 95691 <br /> Phone No4 916 1 372-7535 <br /> C. Describe method to be used for deemitamloadon: <br /> High pressure hot water cleaned. <br /> d. Describe how riusate material will be stored onsite prior to manifesting offslte: <br /> Vacuum truck will remove rinsate from UST as it is cleaned. <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Ramos Environmental ga-brRd0518 <br /> Address 1515 South River Road City West Sacto yip 95691 <br /> Phone No.( 916 ) 371-5747 <br /> Permitted Disposal Site Ramos Environmental <br /> EH 23 046 (Revised 08113199) Pace 4 <br />