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1. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YES kj NO ( I <br /> (h) Is the current certificate of worker's compensation Insurance on tile? YES 04 NO I <br /> (c) Does the contractor possess a "Hazardous Subslaece Removal Certification"? YES P4 NO ( � <br /> (d) flan everyone on site, Including crane/backhoe operator, been certilled <br /> to work an hazardous waste site In accordance with CCR Title 87 YES 04 NO <br /> 2. flits it "Site Health A Safety Plan" for this Job site been submitted? YES t4 NO I I <br /> 3. flits applicant performing removal In the City of"Tracy obtained a "Grading and Excavation Permit"? <br /> N/A K YES I NO I ( If YES, Permit # upon approva 1 <br /> 4. fins the contractor obtained approval from the local fire department to perform tank cutting? NAI I YES( I NON <br /> S. Is there knowledge or evidence of leakage from the tanks) and/or piping? (if yes, please explain) YES I I NO <br /> 6. ff tank rellduai exists, Identify transporting hazardous waste hauler: <br /> Name Nor Cal Waste Oil Haulers Hauler Re&tration 0 CAD 982417255 <br /> Address p• 0. Box 645 City Dena i r, CA zip 95316 <br /> Phone e ( 800 ) 332-8710 <br /> 1. Decontamination Ptecedures: <br /> s. Will tank(s) and piping be decontaminated prior to removal? YES NO I I <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc. <br /> Address P. 0. Box 357 City Lodi Zip 95241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> C. Describe method th he used fnr decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> _and-hn t-wa.ter. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting gffsites <br /> _Rinsate will bither be removed from the tank by the waste oil hauler while <br /> the tank and lines are being rinsed or stored in tabled and sealed drums <br /> ons to untTI they can be removed to a proper disposal ac ty. <br /> e. Rfnsaie Napier and permitted Treatment, Storage do Disposal Facility: <br /> hauler Name same as #6 hauler Registration M <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs , NV 89429 <br /> 5/20 <br /> FII 13 046 (Revised 9/11/96) Page 4 <br />