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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [)I NO [ ] <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES I}j NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Reaaovd C [location 7 YES [ NO I l <br /> 2. Has a Site Health &Safety Plan'for this job site been submitted? YES [)I NO I ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A [A YES I ] NO [ ] HYE4, Permit # Wa i v d — Distrirt, exempt <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[A YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES M NO [ ] <br /> Site currently has 3 monitoring well on it associat d with a leak <br /> from a gasoline tank that was Drevx.ously removed <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name Petroleum Recycling Corporation HanlerRc&tration #EPACAD083166728 <br /> Address 13331 N . Hwy 33 City Patterson Zip 95363 <br /> Phone # ( 800 ) 874-4444 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES IQ NO ( ] <br /> b. Identify contractor performing decontamination: <br /> Name Wright Environmental Services , Inc . <br /> Address 1961 Hill View Way City Tracy Zip 95376 <br /> Phone No.( 209 ) 833-0758 <br /> C. Describe method to be used for decontamination: <br /> Vacuum residual product into tanker truck — rinse tan <br /> interior with water and vacuum rinsate . <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinsate will not be stored on site . Vacuum trunk will remove <br /> rinsate every day as rinsate is generated <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Petroleum Recycling Corp. Hader Registration #EPACAD083166728 <br /> Address 13331 N . Hwy 33 City Patterson Zip 95363 <br /> Phone No. ( 800 ) 874-4444 <br /> Permitted Disposal Site <br /> Page 4 <br />