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I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES H—N—O [ I <br /> (b) Is the current certificate of worker's compensation insurance on rile? YES 11: fP' [ I <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES 1 0 [ I <br /> (d) Has everyone on site, including crane/backhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title S? YES [.r IVO [ I <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ 1 NO <br /> 3. Has appl' rat performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A V YES I I NO I I If YES, Permit # <br /> J. Has the contractor obtained approval from the local fire department to perform tank cutting? NA 'ES[ I NOI 1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES ( ] NO+,--� <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> 1=J en- ((,1?2-�) Hauler Registration # �Z N Z. <br /> Name 1 <br /> Address s. City Zip lLS(. 0 <br /> Phone # 800 q1'2.- SZ.iB4 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [* NO I I <br /> b. Identify contractor performing decontamination: <br /> Name : ANkis s S. "t)61A Aux) ,t4Tnj <br /> Address P• 0• & ,( 303-31 City STDc.IL7'bN Zip 9s Z 13 <br /> Phone No. Z( DI ) 443 - 1-193 (LrA 44-31,S7-14 "A+ <br /> C. Describe method to t be used for decontamination: <br /> McL9 —s 4- TA.uks wl 00,upr Waste• . <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> VA cC-"o— Tilt ,-L <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> �-�" Cao <br /> Hauler Name et/ell-ore,`-•l Hauler Registration OSSWI S <br /> Address 6 S 8 0 .SCity MZ,0A-,.J1, Zip 9 US (o O <br /> Phone No. ( pl00 Q <br /> ) -M-.S-Z Sq <br /> Permitted Disposal Site "Is 000 z qq 0!110 <br /> 5/20 <br /> EH 23 046 (Revised 9/11/96) Page 4 <br />