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0� <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 Permit"? <br /> ' N/A[q- YES [] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[q`YES[1 NO[1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO W <br /> ' 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name � i,Unv� (�Lk i/((MIt�Qt.u'IA-� Hauler Registration# OQ] 5 <br /> Address 2(00 iV f city- o� Zip 90z2-'L <br /> Phone#( 3 ky ) $r6(o ' 3`{00 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[INO[] <br /> ' b. Identify(contractor performing decontamination: <br /> Name eHl,trait C21 A �fgm=ojlLiA.un. <br /> Address 2.0 2 pA `7' City1..i�r._Zip 12s70 <br /> ' Phone No.( CiCJ ) St7 Ff r/a <br /> C. Describe jj��ethod to be used`for decon�ation: <br /> %tel IS�(//[� IZ.'wd�' 1 uri Ffo i.1ra i d2 NC?SS C4yY <br /> d. Describe how rinsate material will be stored onsite prior to manifesting o]fsite: <br /> -rgd zVti STi`7e n'radAreLUur f rc �urul� �rov <br /> e. Rinsate Hauler and permitted Treatment;Storage&Disposal Facility: <br /> ' Hauler Nameh-t- 11 (((f t`y'Qt�n.-+et't.Ha�.. Hauler Registration# <br /> Address ZLCO tl A\�Lr C' ST City (-ov.rro. Zip 90LZZ, <br /> Phone No.( S`i o ) 7 g( -3 p4-DD <br /> tt LI1, (( 11 ,", 1�� S <br /> f1 <br /> Permitted Disposal Site e4�,(-kkt, ILhcw� 7.000 1� , lYk <br /> u T . Ci.ow. I , gbZ1Z <br /> ' EH 23 046 (Revised 07/31/08) 4 <br />