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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES k] NO [ ] (b) Is the current certificate of worker's compensation insurance on file? EXEMPT YES [ ] NO ( ] (NA) (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES $) NO ( ] 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES $] NO ( ] 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? N/A JA YES [ ] NO ( ] If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAP(] YES[ ] NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO N 6. If tank residual exists, identify transporting hazardous waste hauler: TANK RINSEATE FROM CLEANING Name ENVIROPUR WEST CORP. Hauler Registration # 2591 Address 13331 N. HWY 33 City PATTERSON Zip 95363 Phone # ( 209 ) 892 6742 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES JA NO [ I b. Identify contractor performing decontamination: Name JAMES J. HOBLITZELL Address BOX 30331 City STOCKTON Zip 95213 Phone No.( 209 ) 943 7793 C. Describe method to be used for decontamination: HIGH PRESSURE HOT WATER NON CHI ORTNATFD CI FANFR d. Describe how rinsate material will be stored onsite prior to manifesting offsite: IT WILL NOT BE STORED ON SITE IT SHAI I RF IMMEDIATFI Y RFM()VFf1 av VAGI 11 M TRUCK AND TRANSPORTED BY A I TCFNSFD HAUI FR FnR DT-Ro gal Tuoni ir_H RFrvri rnir_ AT A TSC e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name FNVTROP IR WEST MRP Hauler Registration # 2591 Address 13331 N. HWY 33 City PATTERSON Zip 95363 Phone No. ( 209 ) 892 6742 Permitted Disposal Site ENVIROPUR WEST CORP. , PATTERSON, CA Page . SIX