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1. (a) Is there a PRS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES NO[ j <br />(b) Is the current certificate of worker's compensation Insurance on file? YES NO [I <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES" 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 Q( NO [ [ <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES NO[ j <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIAX' YES I ] NO [ J If YES, Permit N <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? N(KYES[ ] NO[ j <br />5. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES [ ] NOV <br />6.i It tank residual exists, identify transporting hazardous wastq hauler. <br />Name U, C, 1 , nnHauler Registration N w19 <br />Address- PhQR NVQ, city zip M&D <br />Phone x ( 510 > 235 —139 3 <br />Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to removal? YES NO [ ] <br />b. Identify contractor performing decontamination: <br />d, <br />Name <br />Address 11336 SOUTH UPALNn 60 City LIATRROP zip 95330 <br />Phone No.( 20 9 ) IM 2450 DjQL— RuRfrgE- <br />Describe method to be used for decontamination: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name�9 <br />G, CJ: , �7 • Hauler Registration B <br />Address 2✓CC pL <br />5 �AQ2 \)D, City QcHmow Zip (�4WI <br />Phone No.( S 10 ) 235 — 1393 <br />Permitted Disposal <br />EH 23 046 (Revised 08113199) <br />Page 4 <br />