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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YE� NO(] <br /> (b) Is the current certificate of worker's compensation insurance on file? YE NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YE NO[) <br /> (d) Has everyone on site,Including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 87 YES, ], NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES NO[J <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA ] YES[] NO[] If YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA]I YES[I NO[[ <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[I N0,[I <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name z r \ Hauler Registration N <br /> Address?, 55 1�-r�R\Z �\\ice city \CAy�o. zip _ <br /> Phone N( S �() ) a-71i �,— <br /> 7. Decontamination Procedures: / <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESp NO[] <br /> b. Identity contractor performing decontamination: `` <br /> Name G-- G <br /> Address 2 Ci 5 �F\� 3 LV� City IZ L\\\`AQ0 ZIP <br /> Phone Nos ,� A r, ) 3 S <br /> C. Describe method to be used for decontamination _ <br /> �Fi\ iI P �\ N St <br /> d. Describe how dnsate material will be stored onsite prior to manifesting offsite: <br /> LS'aI1Y=� T LMS <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name C Hanler Registration M <br /> Address city 4Au <br /> Phone No.( <br /> Permitted Disposal Site C <br /> EH 23 046 (Revised 10119198) Page 4 <br />