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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES)NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES.[]J NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES M NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES NO[) <br /> 3. Has ap Hcant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA W YES[I NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAj 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. If tank residual exists, <br /> ,Identify transporting hazardous waste hauler: <br /> nti <br /> Name k 6cn QP0,1EG I,fHauler Registration# - n <br /> 1 <br /> Address 'b 163 tar zIzJiI`� 1—.KL'( City d ) fit' Zip I5311� <br /> Phone#( <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES M/NO(] <br /> b. Identify contractor performing decontamination: <br /> Name DEL-TEr.W 1l,^ ^^,, q I <br /> Address l b 6114 Cyo u g- WE, City M44LI5 Zip 15-S O <br /> Phone NN <br /> C. Describe method to be used for deco tamin tion: <br /> ,am � , ZOIr s�taP ��►P�� Rlr�l�Ir <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> klwfrM- 1 LgLL $S ?L(MNP&-D 4MYVt�D9A�C�-�f l I�£tui�t►� <br /> e. Rinsate Hauler <br /> /and <br /> "permitted Treatment,Storage&Disposal Facility: <br /> �Q <br /> Hauler Name y l\nl_i (A., V" ( Hauler Registration# 31 q <br /> Address I o o3 Ja 1 AY1� City�� Fr� ) �A % Zip -15315 <br /> Phone No.( M S <br /> Permitted Disposal Site ST�1 O L� t 1 6S ( L£S I <br /> EH 23 046 (Revised 08113199) Page 4 <br />