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I. (a) Is there a PHS-EIID contractor's questionnaire on rite or enclosed? YES a] NO [ ] <br /> (b) Is the current certificate of worker's compensation Insurance on rile? YES ['] NO [ ] <br /> (c) Does the contractor possess a 'Hazardom Sabsbmm Remand CartiH®tion'T YES Q(1 NO [ ] <br /> t Has a 'Site Health & Safety Plan' for this Job site been submitted? YES NO [ 1 <br /> 7. Hasapplicant performing removal In the City of Tracy obtained a 'Grading and Ficavation Permit'? <br /> N/A ;] YES [ 1 NO [ ] if YES, Permit # <br /> 4. Has the contractor obtained approval from the local lire department to perform tank cutting? NA ] YES[ 1 NO[ 1 <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES I 1 NO EA <br /> 6. If tank residual exists, Idkntiry transporting hazardous waste hauler- <br /> Name <br /> aulerName Evergreen Environmental Services hauler Registration # 0242-93 <br /> Address 6880 Smith Ave. City Newark zip 94560 <br /> Phone # ( 800 l 972-5284 <br /> 7. DecontamInstion Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [)] NO ( I <br /> b. Identify contractor performing decontamination: <br /> Name Helmick & Lerner Inc. <br /> Address 3750 Auburn Blvd City Sac Ca. Zip 95821 <br /> Phone No.( 916 ) 4857222 <br /> C. Describe method to be used for decontamination: - <br /> High pressure water with a non- hologeneated cleaner <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> Rinsate will be pumped into a vacuum truck an immediatly disposed of <br /> at a TSDF. <br /> e. Rlnsatb Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Evergreen Environmental Hauler Registration # 0242-93 <br /> Address 6880 Smith Ave City Newark Zip 94560 <br /> Phone No. ( 800 ) 972-5284 <br /> Permitted Disposal site Evergreen Environmental Services Refinery <br /> Page 4 <br />