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1. (a) Is there a PHS-EHD contractor's questionnaire on file)WIwirdim YES 44 NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES 44 NO [ I <br /> (c) Does the contractor possess a'Hazardous Substance Removal CertiSmtion'! YES 14 NO [ ] <br /> 2. Has a 'Site Health &Safety Pbm'for this job site been submitted? YES YJ NO I ] <br /> 3. Has applicant perfooming removal in the Cita of Tracy obtained a 'Grading and Excavation Permit! <br /> N!e YFS [ ] NO ( If YFS, Permit # T <br /> Sial WC w7:t41..v1'�-)Uu led uppnwal from u.e iocai fne department to perform tank cutting? NAS[) YES[ 1 NO[ ] <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO 1$ <br /> 6. H tank residual exists, identify avasporting hazardous waste hauler. <br /> Name Shop Hazard Solutions Hauler Registration # 3�J, <br /> Address-729 N. Golden State Blvdi) 2C� Turlock Zip 95380 <br /> Phone # 800 746-7449 <br /> (— - <br /> 7. Decontamination Procedures: <br /> S. Will tank(s) and piping be decontaminated prior to removal? YES [KIK NO ( ] <br /> b. Identify contractir perfor,ding decontamination: <br /> Name Valley Environmental Solutions <br /> Address P.O. Box 48 City Stockton — zip 95201 <br /> Phone No. 209 ) 547-9000 — <br /> C. Describe method to be used for decontaminatwn: <br /> Triple rinse with with hot water and detergent. Vacuum <br /> rinseate and immediately dispose at a permitte TSDF . <br /> f. _`.. :its.' •5 ori, ,t _�T. ':Ti-i a�.. _ -i -w <br /> r-• oil - r .3 ;3:. t'-.{ . , L�^ :. . -aIle. Q0.'OC:P V <br /> N/A <br /> C. Rinsate Hauler avid peed Treatment, Storage & Disposal Facility: , <br /> Hauler Name_ Nor Cal Oil Hanler Registration # 2412 <br /> Address P .O. Box 645 _ CityDenair ZIP-2 531_6 <br /> Phone Ao. ( 800 _) 332-8710 <br /> PR ATTERSonJ a3 <br /> Permitted Disposal Site Enviropur, Pdtterson, California - <br /> Page 4 <br />