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I. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES IIQ NO [ I <br /> (b) Is the current certificate of worker's compensation insurance on rile? YES pq NO I I <br /> (c) Does the contractor possess a "Hanirdons Substance Removal Certification"? YES}(I NO I I <br /> (d) Has everyone on site, Including crane/backhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title B? YES PQ NO ( 1 <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES K NO [ I <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading N/A Excavation Permit"? <br /> '1 <br /> N/A ' YES I I NO I I If YES, Permit k a7 <br /> 4. fins the contractor obtained approval from the local fire department to perform tank cutting? NA[ I YES( I NON <br /> 5. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES [ I NO Q� <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler: <br /> Name Nor Cal Oil Hauler Registration N CAD 982417255 <br /> Address P.O. Box 645City Denair, CA Zip 95316 <br /> Phone x ( 800 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ I NO <br /> b. Identify contractor performing decontamination: <br /> Name Tanks to hauled as hazardous waste ,to facility listed below. <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: N/A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: N/A <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Americlean, Inc. Hauler Registration N <br /> Address 2570 Almond Dr. City Silver Springs,Zip NV 89429 <br /> Phone No. 800 471-2105 <br /> Permitted Disposal Site Same as above <br /> 5/20 <br /> Ell 23 046 (Revised 9/11/96) Page 4 <br />