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t. (a) Is there a EHD contractors and subcontractor's questionnaire on rile or enclosed? I YES�j NO[] <br /> (b) Is the current certificate of workers compensation insurance on file? / \ YES NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> hazardous waste site in accordance with CCR Title 8? YES Y�(\ NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/Ak' YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA IV <br /> YES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NOK <br /> 6. If tank residual exists,identify <br /> transporting <br /> trans�portingJhazardous waste hauler: <br /> Name � ZZICll ✓ <br /> 5- auler Registration# 12Y <br /> Address SD Q0 / J �O <br /> city --k4 J Zip / S .315 <br /> Phone# <br /> 7. Decontamination Procedures: �) <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES pQ NO[] <br /> b. Identify contractor performing decontamination: <br /> Name_�j/i 7 / R,-?L� Q/L 163 <br /> Address �� f) G V'X �] 5Z City e)ol Zips <br /> Phone No.(�°I ) _ 2- <br /> C. <br /> c. Describe metho to a used for decontamination: <br /> 2�loC� / /JSP 4/!T/� ))S ,?, � -aF/' Slur t9 <br /> t ,cvr > > <br /> CL Describepow nns�e material will be stored onsite prior to manifestin$q 'site: <br /> �.9 f r0� A i1sitc:D ISA �T <br /> C. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name &Vf`� PW e f o, Hauler Registration# <br /> Address /�D `s(( / -3 �40C City ��£��jl� Zip <br /> Phone No. 0() 1 `�j ,� p 7/ <br /> Permitted Disposal Site J[it//7OS 'SeUi///(O�✓/l9fi✓i• <br /> iS/ S Spv>.g IZ/✓£-'t 120-10 W 57C/! ?�f �7�Jcgl 7565/ <br /> 9/6 J 71 S,-7,/47 E `'l IV C,300'/V41 <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> 17/1 �7 /CS 3 O e AS &Eq Z&A2i2 n /-J" <br /> b. Tank/Piping Hauler: <br /> Name <br /> EH 23046 (Revised 12/31/07) 4 <br />