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Oct 09 06 09: 5Ga A R Eroneering 8188423 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? [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YFS NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on YES[I NOrj.]' <br /> (e) 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 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[) NO}- <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO,[a' <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Hauler Registration# <br /> Address 235 ��'[ QW9 City�+1G1[n10fib Zip94/hr <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES [] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name d t= S <br /> Address 325Ca N MOCzKS AC/A city F[29StJ0 zip 9 33722 <br /> Phone No.( S�_) 4 S S d�Z; <br /> C. Describe method to be used for decontamination: <br /> to G E E Wily <br /> FOTA53IU 1nIDG <br /> SOLI/ VAac-OYI712! <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> c . c .5 Emus 4wrs jel4SA T me <br /> Mff AFi''Y uet2 Ont 7 Tlti DLhJ OF 0k <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name O t= S • Hauler Registration # <br /> Address -3-Z9(c) I �M��rS AIS City Z�NO Zip � 2Z <br /> Phone No.( e7C-091_) <br /> Permitted Disposal Site <br /> cJ-ZAOp Gt SUS �zp [Z\�1G� �1� CA <br /> EH 23 046 (Revised 819106) 4 <br />