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9 <br /> (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [X] NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [X] NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES [X] NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES p(] NO ( ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A [A YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[A YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [X] <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. N/A Tanks rinsed <br /> Name Hauler Registration # <br /> Address City Zip <br /> Phone # ( ) <br /> Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [A NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Elite IV Contractors Inc. <br /> Name <br /> Address <br /> 2736 Teepee Drive # C City Stockton, Ca Zip 95205 <br /> Phone No.( 209 ) 461 6337 <br /> C. Describe method to be used for decontamination: <br /> I live <br /> ss moierri„a-;-dc-;1-@dn®r- 'y3CU3tp with vArmim mirk fnr di-,nn-'al at <br /> Treatment, Storage and Disposal Facility (TSDF) through recycling <br /> d. Describe how nnsate material will be stored onsite prior to manifesting offsite: <br /> it i � ninT ti C la�jj off haul immariiataly <br /> c will ice, be s49re�'—Vd6NNm tr6�r� fr9m T CLF <br /> LY-- <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Ems„ 'West 99rpnr;'tinn_ _ Hanler Registration #_2c:ql <br /> Address <br /> 13331 N. Highway 33 City Patterson, Ca Zip 95363 <br /> Phone No. ( 209 ) 392 6742 <br /> Permitted Disposal Site Enviropur West Corporation (as above) <br /> Page J�7 <br />