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I. (a) Is there a PnEHD contractoYs and sabcontracmrs questionnaire on file or enclosed? YESg] NO [ I <br />(b) Is the current certificate of worker's compensation insurance on file? Tail NO[ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification07 YESJ] NO I ] <br />(d) Has everyone on site. Including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with CCH Title 87 YES [d NO [ I <br />2. Has a "Site Health & Safety Plan" for this Job site been submitted? YES W NO[] <br />I Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />MAN YES[] NO[] AYES, Permitil N/A - Site in Stockton <br />4. Has the contractor obtained approval from the local fire department to perform tank tatting? NA[ I YES[ I NOg] <br />5. Is there knowledge or evidence of leakage from the tanks) andlor piping. (lf yes, please explain) YES I I NO ]i] <br />tie h 'denrp nf 1pnknge <br />G. If tank residual exists, Identify transporting hazardous waste hauler. <br />Name No Residuals Hauler Registration d <br />Tip <br />Phone <br />Decontamination Pmcedmes: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NOM <br />b. Identify contractor performing decontamination: <br />Address 255 Parr Blvd. city Richmond ZIP 94801 <br />PhoneNea 510 ) 970-7462 <br />C. Describe method to be aced for decontamination: <br />No decontamination to be performed on site. <br />d. Describe hon rinsate material will be stored onsite prior to manifesting offsite: <br />No rinsate to be stored on site. Tank to be transported to <br />Ecology Control Industries yard for decontamination and destruction._ <br />e. Rlnsate Hauler and permitted Treatment. Storage & Disposal FacMtT <br />Hauler Name Ecology Control Industries Ranier Registration# CAD 982030173 <br />Address 255 Parr Blvd. City Richmond Zip 94801 <br />Phone No. ( 510 ) 970-7462 <br />Permitted Disposal Site Tank to be decontaminated by Ecology Control Industries <br />and scraped at metal recycler. <br />EH 23 046 (Revised 10119198) Page 4 <br />