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I. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES W NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on rile? YES M NO [ ] <br />(c) Does the contractor possess a 'Hamrdous Substance Removal Certification'! YESY- , NO [ ] <br />2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES K NO [ ] <br />3. Has ap licant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit`! <br />N/AYES [ ] NO f ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAK YES[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain)'' YES [ ] NO <br />6. If tank residual e3dsts, identify transporting hazardous waste hauler- <br />Name <br />aulerName Hauler Registration # <br />Address City Zip <br />Phone # ( ) <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name <br />Address City Zip <br />Phone No.( ) <br />c- Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting otfsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Hauler Registration # <br />Address City Zip <br />Phone No. <br />Permitted Disposal <br />Page 4 <br />