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BUSINESS OFFICES Fax : 209-9432811 Jan 28 0638 <br /> 1. (a) Is there a PNS END contractor's and subcontractor's questionnaire on file or enclosed? YES NO[[ <br /> (b) 18 the current certificate of worker's compensation insurance on f1107 YES[ NO 1[ NA (� <br /> (c) Does the contractor possess a'Hazardous Substance Removal CardRcatlon"? YES 0,NO[] <br /> (d) Has everyone an site,Including crauAackhoe operator,been eerdlled <br /> to work on hazardous waste site in accordance with CCR Tide S? YESJX NO[], <br /> 2. Has a"Sits Health&Safety Plan"for thls Job site been submitted? YES K NO() <br /> 3. Has applicant perrorming removal in the City of Tracy obtained a'Brading and Excavation Permit'? <br /> NIAN YES[) NO[] If YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAXYESJ I NO[I <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (if yes,please explain))YES(J NOY <br /> G. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name N/A Hasler Registration/ <br /> Address City_. ZiP <br /> Phone 8 <br /> 7. Decontamination Procedures: <br /> a. Will tank(a)and piping be decontaminated prior to removal? YES NO[I <br /> b. IdUrIty contractor performing decontamination: <br /> JAMES J . HOBLITZELL <br /> Name <br /> Address BOX 30331 City STOCKTON, CA Zip 95213 <br /> Phone No. 2( O9 1 943 7193 <br /> c. Describe method to be used for decontaminadan: <br /> FUEL VENDOR 7 VA URE <br /> WATER S NON HALOGENATEDT CLEANER PRESS1RE WASH AND FXoriinTF— <br /> TANK WITH VACUUM TRUCK AT LEAST THREE C3) TIMZS UNTIL CLEAN/NONHAZ . <br /> d. Describe how floats material will be stored onsite prior to manifesting offsite: <br /> IT WILL NOT BE STORED ON SITE. WILL—BE Y <br /> BY VACUUM !' 'ICK FOR DISPOSAL THROUGH RECY <br /> e. Eineate Hauler and permitted Treanmeut,Storage&DlspoasI Facility: <br /> Hauler Name AMERICAN VALLEY Hauler Registratloni 3744 <br /> BOX 340 CIS DELHI , CAyp 95315 <br /> Address -- <br /> Phone No. SOD 732 4645 <br /> Permitted Disposal Site RIVERBANK OIL TRANSF R RIV <br /> ED 23 046 (Revised 08113199) Page 4 <br />