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0 i <br /> 1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES K'NO[] <br /> (b) is the current certificate of worker's compensation insurance on file? YES W] O[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES W NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Tide 8? YES H--'NO[1 <br /> 2. Has a"Site Health&Safety Playa" for this job site been submitted? YES jr'NO 11 <br /> 3. Hasap t performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAS[] 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)and/or piping? (If yes,please explain)YES[] NO[ <br /> 6. It tank residual exists,Identify transporting hazardous waste hauler. <br /> Name f1 uL� #tcJ4 i-+- lamy l szc A Lm4�auler Registration#.!29q <br /> Address P['� [ �S y Q City L-fit _ zip ,;3 <br /> Phone# �7=.TZ, r qt- <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES NO[l <br /> b. identify contractor performing decontamination: <br /> Name 1 c-sL 5-r�-rie>. fE- - - <br /> Address e6, I 1-I l6el Clty�15-k7-4),d ZIP S' <br /> Phone No( — -a <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rhmate material will be stared onsite prior to manifesting offsite: <br /> _ I l f. D,aeC-T =G� <br /> Alamo r' �1 lGJA I <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility: 'l <br /> Hauler Name) ►x^14 \JjkLLiEqf t4,,jic0t ,,Ta Hauler Registration#5 <br /> i <br /> AddressCll � LI City c��%tt l _ZIP <br /> Phone No.[OO <br /> Permitted Disposal Slte- y-,l i s w&4 L Se vl /C-/ 0/1-' <br /> f UC] "t7p, JG•"� �� L-+CJ .�.> ' '7C=C.C.S C."}=ro��~�e�-1� <br /> EH 2 D46 (Revised 10119198) Page 0 C(C1 '76 <br />