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1. (a) Is there a PHS-F.HID contractor's questionnaire on ole or enclosed? YES M NO <br /> (b) Is the current certificate of worker's compensation Insurance on Rte? YES NO <br /> (c) [)nes the contractor possess a "Hazardous Substance Removal Certification"? YES NO 1 <br /> (d) flat everyone an site, Including crane/backhoe operator, been certified <br /> In work an hayardout waste site In accordance with CCR Title g? YES NO <br /> 2. Ilan a "Site Health A Safety Plan" for this Job site been submitted? YES NO <br /> 3. ling applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/AYES i i No i i If YES, Permit N upon approval <br /> 4. Ilan the canlrsctor obtained approval from the local fire department to perform tank culling? NA( I VLSI l N004 <br /> S. It there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please "plain) YES ( i NON <br /> 6. If tank re4idnal exists, Identify transporting hazardous waste hauler: <br /> Name Nor Cal VIaste Oil liaulers Hauler Re&traflon N CAD 982417255 <br /> Address P. 0. Box 645 _ City Denair, CA Zip 95316 <br /> Phone N ( 800 ) 332-8710 <br /> 1. Deconlemlaalioe Proeedero: <br /> e. Will lank(s) and piping be decontaminated prior to removal? YES DQ NO 1 <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe 011 , Inc. <br /> Address P. 0. Box 357 City Lodi Zip 98241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> e. Describe method to he used for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> -and hot water_ <br /> d. Describe how rinsale material will be stored onslle prior to manifesting rtffsllet <br /> Rinsate will bither be removed from the tank the waste of le <br /> the tank and lines are being rinsed or stored in la led and Sea ell drums <br /> on site not t ey can be removed to a proper disposal facility. <br /> e. Rlnsale Hauler and permiHed Treatment, Storage Rr Disposal Facllllyt <br /> Harder Name same as N6 Hauler Rg*rsflon N <br /> Address City Zip <br /> Phone No. ) <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs , NV 89429 <br /> S/20 <br /> Fit 13 046 (Revised 9/11/96) Page 4 <br />