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C� <br />• <br />1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on Me or enclosed? <br />(b) Is the current certificate of worker's compensation Insurance on Me? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(d) Has everyone on site, including craneibackhoe operator, been certified <br />to work an hazardous waste site In accordance with CCB Title 8? <br />2. <br />3. <br />4. <br />5. <br />6 <br />fel <br />Has a "Site Health & Safety Plan" for this Job site been submitted? <br />Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA (,.f' YES [ ] NO [ ] If YES, Permit R <br />YES W NO ( I <br />YES W NO [ I <br />YES W NO [ ] <br />YES W NO ( ] <br />YES(fA NO[] <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[q'¢ES[ I NO[ I <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ I NO V <br />If tank residual exists, Identify transporting hazardous waste hauler. <br />Name AA6lWAA.1 <br />V,4 yQ <br />e.>� r a L Tr, LC <br />Hauler Registration M <br />3 -7�r <br />Address f.O <br />EoX <br />3-(u <br />City <br />J)6LtjL 71p <br />9S3/S <br />Phonefil 690 1 132_- g6rfs <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES H NO [ ] <br />b. Identify contractor performing decontamination: <br />Name <br />Address 1217 South 7th Street City Modesto yip 95351 <br />Phone Ne4 209 1 524-9653 <br />c. Describe method to be used for decontamination <br />The tanks & piping will be triple rinsed at 180° using a low volume, <br />high pressure washer. The first rinse will include the use of a bio- <br />degradable detergent. The two final rinses will be clean water. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />The rinsate material will be stored on site in DOT 55 gallon drums <br />with annrnpH atp lahpla <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facillty: <br />Hauler Name 4/1 6UClf.j Vkk-t-L:�L/ OLTL)�HaalerRegistration# <br />Address P.O. BOK NO City -DQ-HT yip <br />Phone No.( BOO 1 72-�7- - q&qc- <br />Permitted Disposal Site TiJLUSTQIftt.. S61UC$ OIL (') ZVS AA-lGLES} eA <br />EH 23 046 (Revised 10119198) Page 4 <br />