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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES k NO[] <br /> (b) Is the current certificate of worker's compensation Insurance an file? YES 14 NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certiflcation"? YES Lf NO[] <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,I� NO[] <br /> 2. Has a"Site Health&Safety Pian" for this job site been submitted? YES NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Brading and Excavation Permit"? <br /> NIA YES[I NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAI I YES(I NOP <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? Of yes,please explain)YES(] N0)( <br /> 6. If tank residual exists,Identity transporting hazardous waste hauler. <br /> Name ) ?1 Hauler Registration# <br /> Address City ZIP <br /> Phoned( 1 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping he decontaminated prior to removal? YES(] N0�x <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No4 1 <br /> c. Describe method to be used for decontamination: <br /> bio <br /> d. Describe how rlusate material will be stored onsite prior to manifesting offsite: <br /> WIL <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name 02 i Hauler Registration# <br /> Address City 7iP <br /> Phone No. 1 <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 10119198) Page 4 <br />