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1. (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES [f NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES(a' 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[/J NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A [r]- YES [] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAVfYES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO[tom <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name &L t,,, /Kl, . ra Hauler Registration# (2-D(D[& <br /> Address Z d 0 NF• )k104 k ped-t Sr City r� <br /> [A� Zip 90 LZ 7— <br /> Phone# <br /> Phone#( 31(L) g8(o 3400 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[r)/NO[] <br /> b. Identify contractor performing decontamination: <br /> Name d--O� LA,OOLA 0 ,&T�2—O' (4,u ctMJA.Crtrtm.. .LL,C <br /> Address �• d h oX 1 1 (n c( City "Zip U <br /> Phone No.( 5 3 v ) l 7 $-/y 8"34 <br /> C. Describe Method two be used for decontamination: r <br /> ` s../� 0 1_r)ftAA i-kbtUPl4r � <br /> KPL Ylrt?SS�IVIZ (. ail. um <br /> d. De cube how rinsate material will be stored onsite prior to manifesting offsite: <br /> Scovcc�tL 0t.. ';tt= - (L-iAArAL l�.co <br /> C. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name A&L LAAA ([2 i. V I lZ r :rt-+-V i[lf-Hauler Registration# app (S <br /> Address7.] 0p �- Wl�w tri o1 SC City Zip 90 Z.ZZ <br /> Phone No.( 3 10 1�SFS� — 31400 <br /> Permitted Disposal Site n �•� n� 7-06t) lL 0 O+ &T <br /> EH 23 046 (Revised 07/31/08) 4 <br />