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Oct 09 06 09:56a A R 1kineering 818842*60 p.4 <br />1. (a) Is there a EHD contractor's and subcontractors questionnaire on file or enclosed? YES [ ] NO[] <br />(b) Is the current certificate of worker's compensation insurance on file? YEy[ r NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YFS,W NO [ ] <br />(d) Has everyone on site, including crane/backhoe operator, been certified to work on YES [ ] NOS <br />(e) hazardous waste site in accordance with CCR Title 87 <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES, jr NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/ A,[ ] YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NQ[ }- <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 />Name E e - T _ Hauler Registration# 1s3 <br />Address 235 F6.(2Cz 5L -V9 CityRlGlm1001Jt% zipybb/ <br />Phone # (5E?1.0_ ) 23 - 1$9S <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. <br />C. <br />M <br />Identify contractor performing decontamination: <br />Name V C, `7 <br />Address 32S& N AINAVeyc5 AIr' City r1Z5.,VO zip 9372' <br />Phone No. !7( �) 4 G s - S A-9 cp U;0 <br />Describe method to be used for decontamination: <br />G/ n/ E70 W/ <br />pOTA53/U NvvRoxiaS SOLI/yAGUm T12tIGK- <br />Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: d <br />Hauler Name O C. S • Hauler Registration # 1543 <br />3 <br />Address --Z9(p lS VAR,4S Aft City rkg N0 zip -6 22 <br />Phone No.( C-74;%9_) 46 J -64-66 <br />Permitted Disposal <br />S3� C_t�&us tZo <br />(20a) i�)/o3- R\$1 <br />EH 23 046 (Revised 8/9/06) 4 VA& <br />