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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire an Me or enclosed? YYEES$] NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file?cation" YES±1 <br /> (c) Does the contractor possess a"Hazardous Substance Removal CertiD ? $1 [1 <br /> (d) Has everyone on site,including cranaackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES11 NO[] <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YESA] 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 Ute contractor obtained approval from the local fire department to perform tank cutting?NA�]YES[]NOf d <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NOJ] <br /> never monitored <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name American Valley Waste Hauler Registration f <br /> cal 000827878 <br /> Address po box 340 City delhi �P 9531 5 <br /> Phone#(800 ) 732-4645 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[a NO[) <br /> b. Identify contractor performing decontamination: <br /> Name advanced 4eo environmental inc <br /> Address 837 Shaw road City Stockton gip 95215 <br /> Phone No.( 209 ] 467-1006 <br /> C. Describe method to be used for decontamination: <br /> triple rinse and waste disposal <br /> d. Describe how rinsate materlgl will be stVed onsito nrior to manifestin offsite <br /> purge waste was er wii11 no bbe s oreon—site <br /> waste water will be disposed of as haz waste <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Amercian Valley waste Hauler Registration# <br /> cal 000827878 <br /> Address Po box 340 City delhi zip 95315 <br /> Phone No,( 800 ) 732-4645 <br /> Permitted Disposal Site ; ,,ti„g + t q,r1FjrQr e I ee Gad 099425798 <br /> 1700 s . Soto street los angles ca 90032 <br /> EH 23 046 (Revised 08113199) Page 4 <br />