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• F I <br /> 1. (a) Is there a EHD contractor's and subcontractors questionnaire on file or enclosed? YES b(] NO [] <br /> {b) Is the current certificate of worker's compensation insurance on file? YES V] NO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES)Q NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> (e) hazardous waste site in accordance with CCR Tide 8? YES[-J NO [] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES CI NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[] YES[] NO M If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NO[4 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO[ <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: i <br /> Name Hauler Registration# <br /> Address City Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES kJ NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Gf6 ,�oy /MCo%�poPPrEn <br /> Address e,�.Sr 0 0 i lV 7A C- 7-, S WJE City SZWC 1641"e"W Zip <br /> Phone No.( 57/L <br /> C. Describe method to be used for decontamination: <br /> O2H /CG wi cL ipB Ll sfD TO rz7 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: i <br /> /VO lZ /ivcar[" ofVrie/PArep <br /> i <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Hauler Registration# <br /> Address City Zip <br /> Phone No.( ) <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 10/16/03) Page 4 <br />