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1. (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES)Q NO [] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [I ILIO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES'fk 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 Title 8? YES NO [] <br /> 2. Has a"Site Health & Safety Plan"for this job site been submitted? YES NO [] <br /> 3. Hasapplicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit'? <br /> N/A 1�'I` YES [I NO [] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA)<YES[] <br /> NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES'K <br /> NO [I <br /> rj 1 S e L- <br /> 6. <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: ki A <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 [] NON <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address City zip <br /> Phone No.( <br /> C. Describe method to be used for decontamination: <br /> d. Des cri=w rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: 4 <br /> Hauler Name Hauler Registration# <br /> Address City zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 3/15/02) Page 4 <br />