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1. (a) Is there a PHS-EBD contractor's and subcontractor's questionnaire on file or enclosed? NO(] <br /> (b) Is the current certificate of worker's compensation insurance on Me? NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certiflcatlon"? NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title ST YESA NO[] <br /> 2 Has a"Site Health&Safety Plan"for this Job site been submitted? YES NO[] <br /> 3 Ha`spDcant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/ATA YES[] NO[] It YES Permit 8 \/ <br /> 4. Has//7"th���e contractor obtained approval from the local fire department to perform tank cutting?NAKI YES[]NOH <br /> J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain`) ''YES[J NX <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name 9 Hauler Registration d 1�1,5— <br /> Adareaa?—�� ^ CltyTFFF1f Zip <br /> r <br /> Phone!( (01/ <br /> 7. Decontamination Procedurem <br /> a. Will tank(s)and piping be decontaminated prior to removal? lux <br /> NO[] <br /> b. Identify contractor performing decontamination: / ` <br /> Name izE� � tenon C6/U)✓C%/O)1 <br /> Address r � � Qty ' -NA, � _ $P F <br /> Phone No! r�tf Z� r—�sm x1 C2 * /y3 —3-61-3r- <br /> C. Describe method to be used for decontamination: <br /> 7-Z\ � k-:� I e4 Z\ m 5t <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> e. Rbmsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name E C \ Hauler Registration M <br /> Address Z r� p RSC ��,L\I City \7\ N aP g 4 Ru 1 <br /> Phone No. 0 3 y� <br /> Permitted Disposal se E C <br /> EH Z3 046 (Revised 10119198) Page 4 <br />