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1, (a) <br />• <br />Is there a PHS-EIID contractor's questionnaire on file or enclosed? <br />r <br />YES <br />YTS <br />NO <br />NO ( � <br />(b) <br />is the current'cerilficate of worker's compensation Insurance on flit? <br />"Hazardous Substance Removal Certification"? <br />YES � <br />NO <br />(d). <br />Does the contractor possess a <br />Has everyone on site, Including crane/backhoe operator, been certified <br />CCR Title 87 <br />YES <br />NO <br />to work on hazardous waste site In accordance with <br />2. Has <br />a „Site Elesfth & Safety Plaa" for this job site been submitted? <br />YES <br />NO <br />3. Ilas applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NrA1 YES t j NO 1 I if YES, Permil N _ upon approval <br />vat from the focal fire department to perform lank cutting? NAI ] YES( NON <br />4. Etas the contri�clor obtained appro <br />S. Is there knowledge or evidence of leakage from the iank(s) and/or piping? (If yes, please explain) YES NO N <br />G. if tank residual exists, Identify transporting hazardous waste hauler: <br />Name <br />Nor Cal Waste Oil Haulers' hauler Registration N CAR 982417255 <br />Address <br />P. 0. Box 645 City Denair, CA ZIP 95316 <br />Phone IM $L 8a 332-8710 <br />7. Decontamination Proccdnres: <br />`. Will tank(s) and piping be decontaminated prior to removal? YES NO j <br />b. identify contractor performing decontamination: <br />Name Jim Thorpe Oil, Inc. <br />P. 0. Box 357 City Lodi Zip 95241-0357 <br />Address - <br />209 368-6175 <br />Phone [Vo.�� <br />e, Describe method to be used for decontaminations <br />Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br />and hot w tPr. <br />d. Describe how rinsate material will be stored onsite prior to manifesting gffslte: <br />Rinsate will hither be removed from the tank the waste oil' hauler jqbAle <br />the tank and lines are beitiq rinsed or stored in lab ed and sealed drums <br />on-site until they can be removed,to a proper d1sposal factlity. <br />e. Rinsate hauler and peraaltW Treatment, Storage do Disposal Facility: <br />Hauler Name same as #6 Hauler Registration !i <br />Address City ZIP <br />Phone No. <br />Permitted Disposalsite Americlean, Inc. 2570 Almond Dr., Silver S rin s NV 89429 <br />5120 <br />Eli 23 046 (Revised 9111195) Page 4 <br />