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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES(X NO(] <br /> (b) Is the current certificate of worker's compensation insurance on Me? YES g NO I] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES]}( NO[] <br /> (d) Has everyone on site,Including cranelbackhoe 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 submltted7 YES NO(] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA YES(] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA%YES(]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tanks)and/or piping? (If yes,please explain)YES(] NO X] <br /> G. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name//J`'4!-tl az& Hauler Registration# rJ ZST <br /> Address > City 71p S <br /> Phone#(_g�� <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YE;J� NO[] <br /> b. Identify contractor performing decontamination: <br /> Name 17�y 111 w—, loe, <br /> Address �� X41( �s7 Cit'! ZIP <br /> Phone No DSIr> 1p�71� <br /> C. Describe/method to a used for decontamination: <br /> �jTZI i7� �'� rUlfP.� <br /> d. Describe ate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler a y: <br /> /nd permitted Treatment,Storage&Disposal FacWt <br /> Hauler Name /►/r Hauler Registration# <br /> Address /FZI) I Ar " City el Zip <br /> Phone No.L&K2 //37 <br /> Permitted Disposal Site / �i///(���/I J�/W,001- ?S–f I "4 <br /> EH 23 046 (Revised 10119198) Page 4 <br />