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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES N NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES N NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES N NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES ] NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YESj] NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA's YES[] NO[J If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAVES[J NO[] <br /> 5. iq tiipre k„nwIptiap nr evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[J NOX <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name American Valley Waste Oil Haul e r Hauler Registration# CAL 000827878 <br /> Address P.O. Box 340 City Delhi , CA Zip 95315 <br /> Phone#( 800 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESZJ( NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc . <br /> Address P.O. Box 357 City Lodi , CA ZIp 95241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> C. Describe method to be used for decontamination: <br /> Tank(s) will be triple rinsed with a biode�zradeable soalpso ution <br /> and hot water. The associated lines will be done in a similar way. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinseate will either be removed from the tank and lines as they are <br /> being ri nspd h3z the waste haul Ar- or RtQrQd in Ec^irr��, f 1'abl eri until <br /> they can be pumped out . <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler NameAmerican Valley W.O. Haulers Hauler Registration# CAL 000827878 <br /> Address P.O. Box 340 City Delhi , CA Zip 95315 <br /> Phone No.( 800 332-8719 <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs , NV <br /> or other approved facility. <br /> EH 23 046 (Revised 08113199) Page 4 <br />