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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES N NO [ ] (b) Is the current certificate of worker's compensation insurance on rile? YES W NO [ ] (c) Does the contractor possess a 'Hazar o Substance Removal Certification`! YES (y.] NO [ ] 3. Has a 'Site Health & Safety Plan' for this job site been submitted? YES .'] NO [ ] 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Emavation Permit'^. N/A [I], YES [ ] NO [ ] If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAk] YES( ] NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] NO 6. If tank residual exists, identify transporting hazardous waste hauler. Name FALCON ENERGY Hauler Registration # 2463 Address P.O. Box 1257 city STOCKTON,CA zip 95201 Phone # ( 209 1 463 7108 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES I ] NO [ ] b. Identify contractor performing decontamination: Name FALCON ENERGY Address P n Rnx 1757 City �TnCKTnN�CA zip 95701 Phone No.( 7ng , 4E 71 OR C. Describe method to be used for decontamination: _P P TANKS OF At I RFSTTIIIAI S ANTI CONTATN FOR IITSPOSAI UNDER MANIFEST. RINSE TANKS ANTI CONTATN FnR nTSPO4AI , IISF TIRV TCF AT �n 1 RS./1 .nun (-,At TANK CAPACITY UNTIL GUIDELINES FOR REMOVAL ARE MET d. Describe how rinsate material will be stored onsite prior to manifesting offsite: WTI I NOT, TT WTI I RF CONTATNFTI IN VACUUM TRACK FOR TITSPOSAt e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name FALCON ENERGY Hanler Registration # 2463 Address P.O, Box 1257 city STOCKTON,CA zip 95201 Phone No. ( 209 i 463 7108 Permitted Disposal Site GIBSON ENVIRONMENTAL Page 4