REMOVAL 1995 - Laserfiche WebLink

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1. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YESi[X] NO [I (b) Is the current certificate of worker's compensation insurance on rile? YESAA NO [ ] Yes and see copy attached — (c) Does the contractor possess a 'Hazardons Substance Removal Certification'? YES )[A NO j ] 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YESIA NO j J 3. Has applicant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit'? N/A R$ YES [ J NO [ ] If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YEW] NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES*] NO [ J May 7, 1993 - An Unauthorzed Release Form was filed by Michael Infurna Jr. of the San Joaquin County Public Health Department - Environmental Health Dept. 6. If tank residual exists, identify transporting hazardous waste hauler: L Name Refinery Services Hauler Registration # 2591 �. Address 13331 North Highway 33 Clty Patterson Zip 95363 I v/ Phone # ( 800 ) 874-4444 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES*] NO j ] b. Identify contractor performing decontamination: Name Ramcon Engineering & Environmental Contracting, Inc. Address 3751 Commerce Drive City W. Sac, Ca Zip 95691 Phone No.( 916 ) 372-7535 c. Describe method to be used for decontamination: Tanks and piping will be thouroughly cleaned with a "Ripper 2" solution. d. Describe how rinsate material will be stored onsite prior to manifesting offsite: Vacuumed into DOT approved drums or vacuumed directly into vacuum trucks e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name Refinery Services Hauler Registration # 2591 Address 13331 N Highway 33 City Patterson Zip 95363 Phone No.( 800 ) 874-4444 )( _� Permitted Disposal Site Industrial Oil Page 4