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1. (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[] NOK <br /> (b) Is the current certificate of workets compensation insurance on file? YES.[ NO [1 <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES VNO(] <br /> (d) Has everyone on site, including crane/backhoe operator,been certified to work on <br /> hazardous waste site in accordance with CCR Title 8? YES []50(I <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES VNO[] <br /> 3. Has app ant 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[q--6S[] NO[]'/ <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES [] NO(y <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name l Hauler Registration# <br /> Address Cr t • CityZip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)anpiping b decontaminated prior to removal? YES NO[] <br /> b. Identify contractor performing decontamination: <br /> Nam �l, �t ��1C_ <br /> Address ,�)� f v L alms-1 � City 5MC6-� zip <br /> Phone No.( , 333 <br /> C. Dscribe method to be fol decontamination: <br /> tig�> t')1 / Re F-L <br /> W 1&' <br /> d. Describe how rinsate material will be stored onsite prior anifestmg offsite: <br /> T� �RI « 1� 1�e ,uJ <br /> ,pD '� f�4rry t <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> HaulerName V:FCtFp�l�,Hauler Registration# <br /> Address PQ cult —;40CityDatt\ _Zip�[� <br /> - <br /> PhoneNo.(CO <br /> Permitted Disposal Site y — ICQ. 01rG. <br /> 1QAL-6-5 (4, �i�8 , 195-2 3 <br /> 8. a. Descnbe the�method that will i to rge and/or inert the tank( <br /> b. T ipi g Haulei: <br /> Name' '®c�.a J�rlLV I ep— <br /> e <br /> E 11 046 (Revised 12/31/07) 4 <br />