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I 1 <br /> 1. (a) Is there a PH&EHD contractor's and subcontractor's questionnaire on the or enclosed? YE NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YE NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YE NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES ], NO I] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES NO[] <br /> 3. Has"plicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/Ayk YES[] NO[] If YES, Permit# \/ <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAKI YES{]NOS[]� <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? Of yes,please explain)YES[] NO,I4 <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler: <br /> Name�,: \ Hauler Registration# 5 3 <br /> Address "C'j\ ,j city F, C_\ y�U zip�� _ <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES� NO[] <br /> b. Identify contractor performing decontamination: <br /> Name—& [, <br /> Address 2, S {�f��� `—y� City 1Z \ \\�l0 N Zip U 1 <br /> Phone No.(�`� <br /> C. Describe method to be used for decontamination: <br /> - 7-1,V k-11I e� F�\ w SE <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> _ A E iL� ^L \�L M <br /> I--- <br /> 0. Rlnsate Hauler and permitted Treatment,Storage&Disposal FacWty: <br /> Hauler Name Hauler Registration# <br /> Address City�.\C71p �U1 <br /> Phone No. <br /> Permitted Disposal Site L_ <br /> EH 23 046 (Revised 10/19198) Page 4 <br />