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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES QQ 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 [h] 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 [31 NO ( [ <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [4 NO [ [ <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA X YES [ [ NO ( [ If YES, Permit # <br /> 4. Has the contractor obtained approval f:-om the local fire department to perform tank cutting? NAP([ YES[ [ NO( [ <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES ( [ NO [K[ <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name Allied Petroleum Hauler Registration # 1158 <br /> Address P•O• Box 193Ci ty Zip p 95352 <br /> Phone # ( 209 ) 576-8500 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [X[ NO ( [ <br /> b. Identify contractor performing decontamination: <br /> Name SEMCO <br /> Address 1217 S. 7th St. City Modesto Zip 95351 <br /> Phone No.( 209 ) 524-9653 <br /> C. Describe method to be used for decontamination: <br /> The tanks & piping will be triple rinsed at 180° using a low volume, high <br /> pressure washer, The first rinse will include the use of a i egra e <br /> detergent. The two final rinses will be clean water. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> The rinsate material will be stored on site in DDT 5b gallon drums with <br /> appropriate labels <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Allied PetroleumHauler Registration # 1158 <br /> Address P.O. Box 193 City Modesto Zip 95352 <br /> Phone No. 209 ) 576-8500 <br /> Permitted Disposal Site Americlean - Silver Springs, NU <br /> 5/10 <br /> EH 23 046 (Revised 9/11/96) Page 4 <br />