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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES11 NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YESJ] 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 <br /> to work on hazardous waste site in accordance with CCR Title 8? YES*] NO[1 <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YESA] NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA*] YES 1] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAQ YES[1 NOW <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? Of yes,please explain)YES[] NOJ] <br /> never monitored <br /> G. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name American Valley Waste Hauler Registration# <br /> cal 000827878 <br /> Addresspo box 340 City delhi �P 9531 5 <br /> Phone#(800 ) 732-4645 <br /> 7, Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES pt NO[] <br /> b. Identify contractor performing decontamination: <br /> Name advanced geo environmental inc <br /> Address 837 shaw road City Stockton 7Ap 95215 <br /> Phone No.( 209 ) 467-1006 <br /> C. Describe method to be used for decontamination: <br /> triple aarl1inse nuand waste disposal <br /> u <br /> d Describe hoprirgtemwasteeDwastreionsitl�[�ornor be stored on—site <br /> waste water will be disposed of as haz waste <br /> e. Rhrsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Amercian Valley waste Hauler Registration# <br /> cal 000827878 <br /> Address po box 340 City delhi yip 95315 <br /> Phone No.( 800 ) 732-4645 <br /> Permitted Disposal Site inA t i i d 0994o5_7()8 <br /> 1700 S . soto street los angles ca 90032 <br /> EH 23 046 (Revised 08113199) Page 4 <br />