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I. (a) Is there a PAS-EHD contractor's questionnaire on Hie or enclosed? YES [4 NO [ J <br /> o. (b) Is the current certificate of worker's compensation insurance on rile? YES [A NO [ ] <br /> (c) Does the contractor possess a 'Hanrdoua Substance Removal Cc tificntioo'? YES [I NO ( 1 <br /> 2. Has a 'Site Health &Safety Plan' for this job site been submitted? YES [Y] NO [ ] <br /> 3. Ilas applicant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A [\] YES [ 1 NO [ ] If YES, Permit # Wai verl — L2j.9trict exempt <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[A YES[ 1 NO[ ] <br /> 5. Is there knowledge or evidence or leakage from the tank(s) and/or piping? (byes, please explain) YES D7 NO [ J <br /> Site currently has 3 monitoring wells on it associated with a leak <br /> from a gasoline tank that was previouQly removed <br /> 6. If tank residual exists, identify transporting hazardous waste hander. <br /> Name petroleum Recycling Corporation Hauler RcCishration #GPACAD083166728 <br /> Address 13331 N . Hwy 33 CityPatterson Zip 95363 <br /> Phone # ( 800 874-4444 <br /> 7. Decontamination Procedures: <br /> 1 a. Will tank(s) and piping be decontaminated prior to removal? YES 141 NO [ 1 <br /> b. Identify contractor performing decontamination: <br /> Name Wright Environment:.a]. r;orvicer; „ ]:nc . <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 tank <br /> interior with water and vacuum rinsate . <br /> d. Describe how rinsate materinl will he stored onsite prior to manifesting ofisitc: <br /> Rinsate will not be stored on site . Vacuum trunk will remove <br /> rinsate every day as rinsate is generated <br /> C. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Petroleum Recycling Corp. Hauler 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 />