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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire an file or enclosed? SEs [ j NO [ j <br />(b) Is the current cert111cate of worker's compensation Insurance an file? YES Kj NO [ j <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES M NO [ [ <br />(d) Has everyone on site, Including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with CCR Title 8? YES (C[ NO [ <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ J NON <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIAll YES [j NO[[ 11YES, PermitR N/A — Site in Stockton <br />4. Has the conn acmr obtained approval from the local fire department to perform tank cutting? NA[ j YES[ j NO[ [ <br />a. Is there knowledge or evidence of leakage from the tank(s) andior piping? (If yes, please explain) YES [ J NO J j <br />Thp rant, iq n 'ally ringted out, but we have no evidence of leakage <br />S. If tank residual Aidan, hfeatlfy transporting hazardous waste hauler. <br />Nam Nn R c i du a l c Hauler <br />Address City_ <br />Phone f( ) <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal?," <br />b. Identify contractor performing decontamination: <br />Name No Residuals <br />Address L7t9 <br />Phone <br />C. Describe method to be used for <br />u <br />d. Describe how dm mre material store rite prior to manifesting offsite: <br />No rinsate to be generated <br />e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Y[' NOW <br />Hauler Name Not required Hauler Registration# <br />city <br />Phone No. <br />E. <br />Permitted Disposal Site Tank to he mechanically crushed and sent to metal recycler <br />EH 23 046 (Revised 10119198) Page 4 <br />