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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES(j NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES[] NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[] NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been terrified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES[] NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES[] 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 the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[] NO[] <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler: <br /> Name�e/ �L} c�e haU, l;2md9L iW(�, Hauler Registration# <br /> Address ✓fro B o X l/SYo city �z) zip Z? 776 <br /> Phone#( <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[t]`NO[] <br /> b. Identify contractor performing decontamination: <br /> Name �g it a`GO <br /> � 47S-70 , <br /> Address�`� /� / / Lhn��/� 1�Lam- City P�t N� zip <br /> Phone No.( 07 <br /> C. Describe method to be used for decontamination: <br /> /LGJ $ Im G G.j/42S k <br /> d. Describe how rinsate material willbe stored onsite prior to manifesting offsite: <br /> 414-<i TSN"< <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler NameR // Uq / o U, 9? Hauler Registration# <br /> Address City ziP <br /> Phone No.( � <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 08113199) Page 4 <br />