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_, �... <br /> (a) Is there a 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 NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[ NO[] <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 NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Per-nut"? <br /> N/A W YES [] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?;W"J.-;NO[J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please ' <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Al, l"L4 (-J�/ ( AX(/-1 Hauler Registration# oQ 1 5 <br /> Address AtV---� AtA t" City o, Zip 9oZ7-z <br /> Phone#( 3 to ) t cd., ' 3'A OD <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES P11NO[] <br /> b. Identify Icontractor performing decontamination: <br /> Name d1 L 1n.-1 C- A Fac,rb-h F(UA, u.A. <br /> Address `71 �,cf City s . Zip 9 <br /> Phone No.( C-26-' <br /> C. Describe method to be used1or decontam) ation: <br /> At l a is-cy -i a Pre(,S e,4 V.rt ' �(f-A <br /> V a v«r f f <br /> d. Describe how rinsate material will be stored.onsite prior tom9nifesting o rte: <br /> i n qG O !ii Z, c <br /> 14Wkc-rhi P1 r-6 be2 r i L".C <br /> C. Rinsate Hauler and permitted Treatment;'Storage&Disposal Facility: <br /> Hauler Name 1 4,vi KV,1,/t`ray,t,.-fr1vL AL Hauler Registration# 6(DIS� <br /> Address g lob �, 1 uiUk edcn �T City C-o ut�,p rt-ot-- Zip 9 Q 1,7-7- <br /> Phone <br /> rZZPhone No. <br /> Permitted Disposal Site z000 <br /> EH 23 046 (Revised 07/31/08) 4 <br />