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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [ NO [ J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES ( J NO [A <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [ J NO [ J <br /> (d) Has everyone on site, including crane/backhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES [KJ NO [ J <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES bq NO [ J <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A)d YES [ J NO [ J If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAW YES[ J NO[ [ <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO A <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: q <br /> Name&br1L1�1'Vo %1- C�y��o.�rn2.r�TS� Hauler Registration # a/ <br /> Address 2513D CnZQ r V City—I�i �oLk Zip 553%0 <br /> Phone # ( $00 1-2- <br /> 7. <br /> Z7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES J J NO <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Hauler Registration # <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> 5/20 <br /> EH 23 046 (Revised 9/11/96) Page 4 <br />