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1, (a) Is there a PIIS-FHD contractor's questionnaire on file or enclosed? YES kj NO ] [ <br /> (b) Is the current cerilflcate of worker's compensation insurance on file? YES N NO [ ] <br /> (c) Does the contractor possess a "Hazardous: Substance Removal Certiticatioa"? YES NO <br /> (d) Ilas everyone on site, Including crane/backhoe operator, been certified YES �Q NO [ ] <br /> to work on hazardous waste site in accordance with CCR Title 8? <br /> 2. Has a "Site Health & Safety Plan" for this Job site been submitted? <br /> YES lvol ] <br /> 3. Has applicant ,performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA Dd YES [ ] NO [ ] If YES, Permit # __upon a royal <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ [ NON <br /> 5. Is there knowledge or evidence of leakage from the lank(s) andlor piping? (If yes, please explain) YES [ ] NON <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler: <br /> Nor Cal Waste Oil Haulers CAD 9$2417255 <br /> Name Hauler Registration #, <br /> Address <br /> P. 0. Box 645 City Denair, CA Zip 95316 <br /> Phone 8L 00) 332-8710 <br /> 7. Decontamination Procedoros: <br /> a. 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 /> Address <br /> P. 0. Box 357 City Lodi zip 95241-0357 <br /> Phone No.( 209 368-6175 <br /> ) <br /> c, Describe method to be used for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> and hat water. <br /> d. 'Describe how rinsate material will be stored onsile prior to manifesting Offslle: <br /> Rinsate will hither be removed from the tank the waste oil hauler while <br /> the tank and lines are being rinsed or stored in fabled and sealed drums <br /> on s to until they can be removed to a proper disposal facility. <br /> e. Rinsate hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name same as #6 Hauler Regfttratioa #� <br /> Address City zlP <br /> phone No. (��} <br /> Permitted Disposal Site Ameri cl ean, Inc 2570 Almond Dr. , Si 1 ver Spri n s IAV 89429 <br /> 5120 <br /> EH 23 046 (Revised 9111196) Page 4 <br />