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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES]t] NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES k] NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES 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 g] NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES Id NO[] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA ) YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]N0[4 <br /> 5. is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO�Q <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name Ecology Control Industries Hauler Registration#CAD982030173 <br /> Address 255 Parr Blvd. City Richmond Zip 94801 <br /> Phone#( 510 ) 235-1393 <br /> 7. Decontamination Procedures: <br /> a. Will tazM s)and piping be decontaminated prior to removal? YES]i] NO[] <br /> TANK <br /> b. Identify contractor performing decontamination: <br /> Name ECI <br /> Address 255 Parr Blvd. City Richmond Zip 94801 <br /> Phone No.( 510 ) 235-1393 <br /> C. Describe method to be used for decontamination: <br /> Tank will be emptied of fuel then triple rinsed using hot water and <br /> biodegradable soap. The rinsate will be contained in drums. Piping will <br /> be drained into the tank. <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> Rinsate will be drained, labeled and manifested for offsite disposal <br /> the day of tank rinsing. <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name ECI Hauler Registration# CAD982030173 <br /> Address 255 Parr Blvd. City Richmond Zip 94081 <br /> PhoneNo.( 510 ) 235-1393 <br /> Permitted Disposal Site Crosby & Overton, 8430 Amelia Street, Oakland, Ca. 94621 <br /> EH 23 046 (Revised 08113199) Page 4 <br />