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1. (a) Is there a PHS EHD contractor's and subcontractor's questionnaire on file or enclosed? YES k NO[J <br /> (b) Is the current certificate of worker's compensation Insurance on file? YESX NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESK NO[J <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[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YESX NO[J <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAK YES(( NO[J If YES. Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAJ4 YES[J NO[1 <br /> 5. is there knowledge or evidence of leakage from the tanks)and/or piping? Of yes,please explain)YES[J NOX <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Hauler Registration d <br /> Address City Zip <br /> Phone N L <br /> 7. Decontamination Procedures: <br /> a. Will taak(s)and piping be decontaminated prior to removal? YES 0, NO[J <br /> b. Identify contractor performing decontamination: <br /> Name �Q�� SU C, - i,c <br /> Address y I L( _7 cityup <br /> Phone No4 ) & _ I5 70 0 (tog) 58,/- /1009 <br /> C. Describe method to be used for decontamination: <br /> ��o1e 2irse. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offslte: <br /> t4 L k\ he e i D 55 callM-�dCAAlPn5 <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name A 5 bU f q I t\U i O rner Hamer Registration/0015 <br /> Address: iCOiJ(Ala,.v)2dQ .Jt, cit' Pati zip <br /> Phone No.( 210 ) Age,,-3/Coo <br /> Permitted Disposal Site `�05 <br /> EH 23046 (Revised 08113199) Page <br />