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`oe <br /> I. (a) Is there a f HS-EHD contractor's questionnaire on file or enclosed? YES pQ NO <br /> (h) Is the current certificate of worker's compensation Insurance on Ole? YES M NO <br /> (e) Does the contractor possess a Ilazardous Substance Removal Certification"? YES Iq NO <br /> (d) Has everyone on site, including crane/backhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES pt, NO <br /> 2. Has a "Site Health & Safety Plan" for this Job site been submitted? YES pQ NO <br /> 3. Ilan applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A)4 YES I I NO I I If YES, Permit 8 <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA" YES[ I NOI I <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain) YES ( I NO X <br /> 6. If lank residual exists, Identify transporting hazardous waste hauler: <br /> Name Nor–Cal Waste Oil haulers hauler Registration 0 CAD9824179F5 <br /> Address P.O. Box 6/r City Denair CA ZIPa5�116 <br /> 1J' <br /> Phone M ( 800 ) 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ I NO [ I <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil, Inc. <br /> Address <br /> P.O. Box 357 City Lodi, CA Zip 95241-0357 <br /> 209 368-6175 <br /> Phone <br /> C. Describe method to be used for decontamination: <br /> Triple rinse with hot water and biodegradeable soap solution. <br /> d. Delcribe howrinsate material will be stored onsite rlor to manifesting offsite: <br /> Rinsate will be pumped directly from Elie tank into the waste hauler vehicle <br /> op pumped into hattel D ctnrai t r ' i <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Ifauler Name Same as 716 Hauler Registration R <br /> Address City Z1p�— <br /> Phone No. ( ) <br /> Permitted Disposal Site Refinery Services, Patterson, CA or other approved facility. <br /> 5/20 <br /> Ell 23 0,16 (Revised 9/11/96) Page 4 <br />