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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [tt1 NO [ ] (b) Is the current certificate of worker's compensation insurance on file? YES NO [ ] (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [ ] NO [AI (d) Has everyone on site, including crane/backhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES [y] NO [ 1 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES b.] NO 11 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A (KI YES [ I NO I 1 If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAIA YES[ I NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO M 6. If tank residual exists, identify transporting hazardous waste hauler: Name lr V t(2- 4'i e EFhA Hauler Registration # 07-47- Address 2.42Address 108So S M %rm AQ e City OeLwLy— Zip 9 t/S(o o Phone # ( $00 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES [f1. NO [ ] b. Identify contractor performing decontamination: Name -TatA6S od -tT��- IQ55OciA .-�1 Address P.O, 60X 3O'',a, 1 C i ty-5-McAL-MJ Zip 95Z.I3 Phone No.( -Lo9 1 9 q2�- -1-192 l l'.. "A 'tt 3 bS234 HA4- c. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: VAC CU.r. ZTt.u.e k.. e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: CA10 Hauler Name EUMA790W Hauler Registration # q80837'08 Address 66 S ci 5 pn ,hj Au a City [Jc<J Ad/L, Zip 9 4 S b o Phone No. ( SOO - 51L$4 Permitted Disposal Site CA)( 000 244o4b 5/20 EH 23 046 (Revised 9/11/96) Page 4