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Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES NO <br /> [ ] <br /> 60 <br /> (b) Is the current cerdfjczte of workers compensation insurance on file? YES rel^ NO [ ] <br /> �.. (c) Does the contractor possess a 'Haxardons Substance Removal Certincation'? YES r1c1 NO [ ] <br /> ` Has a 'Site Hea.Ith &Safety Plan' for this job site been submitted? AVL-Vr µb YES Y'C `p [ ] <br /> `" 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Eicavation Permit^ <br /> N/A) YES f ] NO E ] If YES, Permit <br /> Has the contractor obtained approval from the local lire department to per~ <br /> t cuttin NA( l lE ANO[ ] <br /> 5. Is there knowledge or er-idence of Ieakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] 1 NO <br /> V ,\ <br /> fir <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name_ CLy]t^sj�2,,yti/jryl�yl _ Hauler Registration # Q�f c� <br /> *'' Address_) �[S '5;tV 7-H /ZVe—P— So^-6 City 1^!. Si#-�7`a Zip 6cz <br /> Phone # ( �) f — ZS-20 <br /> 7. Decontamination Proaednms: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES NO ( ] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> kLL <br /> Address ZSLVI) City /11C—Zzi <br /> P <br /> F Phone No.( 52 0 ) 32 Z— 9111 OCA <br /> w, <br /> C. Describe method to be used for decontamination: <br /> ITA P l.r-- 1 W /a Lr <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> W . 15 11acw•,rr�....Zxl r /72 <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name S/172E" IAIFV AS I;t;kF, Hauler Registration # <br /> Address City zip <br /> TWO Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />