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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enciosed7 YES[� 0 I] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES(�0(] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification"? YES J/NO[] <br /> (d) Has everyone on site,including cranefbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 87 YES ki/NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES�ANO(] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA(Ir YES I I NO[I If YES, Permit q <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA�f/YES[]NO[I <br /> a. 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 exists,identify transporting hazardous waste hauler. <br /> Name f'+1 ey1,(CAY) LnVA(0M0Y)+a,1 Hauler Registration# Z. ODala l(b� <br /> Address Ol"!Jd Grpv1�E City -Urloa, zip <br /> Phone# Vo 1W '7�Qy.�j <br /> 7. Decontamination Procedures: <br /> a. ;9111 tanks)and piping be decontaminated prior to removal? YES W NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Pa ArA- Poy(fh q <br /> Address Lq (Yl17Qn City &pori Zip q,�5(40 <br /> Phone No{ am 1 5 9a' <br /> c. Describe method to be used for decontaminatlm <br /> yimlab ti uyia <br /> d. Describe how dnsate material will be stored o°q��ite prior to manifesting offsite: <br /> �t QL llm d.VllIMS <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name �l /y]QJ[, rl j('Q((�t� E-nVir0r)MLlNfp,( HH(a'ulerRegistration# NL DCGOn/�J/5[� <br /> Address 050 l^ P✓ 'I(�. City /Uf10CK 71p_C <br /> PhoneNo.( U0 <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 10119198) Page 4 <br />