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0n <br />M <br />1. (a) Is there a FHS-EHD contractor's and subcontractor's questionnaire an file or enclosed? YES W NO[] <br />(b) Is the current certificate of worker's compensation insurance on file? YES bi No [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES ]bi NO [ j <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 fA NO ( j <br />2. Has a "Site Health & Safety Pian" for this job site been submitted? YES H NO[] <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA [.-jam YES [ ] NO I j If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? N4YESRNO(1]' <br />5. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES I ] NO iyy <br />6. If tank residual exists, Identify transporting hazardous waste hauler. <br />� <br />p 5G <br />Name ASGQ 4.� EolIr\ kt4k-A" ram- Hauler Registration # 00 15 <br />Address )OU W yAL(dtGo (�Q, City T?,OrCJn zip <br />Phone # ( 14 G O <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [s j NO[] <br />b. Identify contractor performing decontamination: <br />Name SEMCD <br />Address 1217 South 7th Street <br />City Modesto <br />7,1p 95351 <br />Phone No{ 209 ) 524-9653 <br />Describe method to be used for decontamination( 1 F (Zi V1`�t 2 i o – I A� K 1-K�Yt 0 uSt Clbf 1t�> <br />The tanks. &. will be triple rinsed at 1800 using a low volume, <br />degradable detergent. The two final rinses will be clean water. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />The rinsate material will be stored on site in DOT 55 gallon drums <br />Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name &pr�(I(({Oit ML4,1TA& HHaa�ule"r'Registratio`1n# cr)0 1' <br />Address � O0 ( A , 6 L91 n c©. City icl rvN (.j, . Zip C j 7 (e <br />PhoneNo.( 20cli ) _gs-:— i(o 6o0 <br />Permitted Disposal Site 14 , 5EQ1 Y) at4 M ujTAL - ybugw 1 to <br />EH 23 046 (Revised 10119198) Page 4 <br />