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I <br /> I (a) Is there a PHS-EHD contractor's and suhcontractor's questionnaire on file or enclosed? YES[1( NO[1 <br /> (b) Is the current certificate of worker's compensation Insurance an file? YES[rj'NO() <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES F{' 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[1j�NO <br /> 2. Has a"Site Health&Safety Plan" for this Jab site been submitted? YES NO <br /> 3. Has'✓applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA n YES11 NO[) If YES, Permit p �� <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NApJ YESI(NO[) <br /> I <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[[ NO <br /> j 6. If tank residual exists,idenppty transporting hazardous waste hauler: 't"v\v�ks PIAOT R t=.w..puILL D. <br /> �rPc�J Z�Siclvl.1 will b� nuc �v To t��1 t. <br /> Heiser Registration A <br /> Address Clty __ ZIP <br /> Phone N( ) <br /> 7. Decontamination Procedures: <br /> a Win feslt(e}end piping be decontaminated prior to removal? YES 14 NO J J <br /> b. Identify <br /> ,contractor performing decontamination: <br /> Name tet^o` �6tft'tt•6A1M Gmn�Yiwt tCn" <br /> Y • �, ,� <br /> Address _R o X `7)is(A City A�r!NN 7Ap_�teb <br /> — <br /> Phone No( $b0 ) 878 -( 214 <br /> C. Describe method to be used for decontamination: <br /> Sre4ama [' ?trig psi t y JfZC-LoiAi[ryz tyu.tLP,rt, <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> �-rtzirk, 12(t,t.eVN Vt3 is, Dui tor 4Sbr Dicictk <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name (ASb11i.1ntn Lvul ,S'�rVHauler Registration 0 _ Q() I �_ <br /> Address. bD N IA'W1/t".2�IP, S117 City—Cl_Q 6vjp Tt?N_ZIP _CAO L7,..'1_ <br /> Phone No.( \. <br /> Permitted Disposal Site tLo-le"5 (..V%.V l 1 S St, . Izi V&I-L kz A ,I''ss c-CE r.LYa r( �_!o rk I <br /> EH23O46 (RevlsedO8113199) Page <br />