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(a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on Me or enclosed? NO[] <br /> (b) Is the current certiIIcate of worker's compensation insurance an rile? NO I) <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certmeadon"? NO[J <br /> (d) Has everyone on site.including cranelbaekhoe operator,been cer=ed <br /> to work on hazardous waste site in accordance with CCR Title 8? YESA NO I] <br /> Has a"Site Health&Safety Plan"for this job site been submitted? YES NO[ <br /> Etas applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N1Ab4 YES() NO(J if YES, Permit P <br /> Ham//!�th"`e contractor obtained approval from the local fire department to perform tank coning?N1 """YES(J NO[j <br /> Is there knowledge or evidence of leakage from the tanks)andlor piping? (If yes,please explain)YES(j NO <br /> 11 tank residual exists,identity transporting hazardous waste hanler. <br /> Name r Hauler Registration# 1 5 3 <br /> Address 2. 5 5 Pr�,Z� L'1\y� City R C H yo Mp�� <br /> Phone dl( 5 \C) - <br /> Decontamination Procedures: <br /> a. WM tank(s)and piping be decontaminated prior to removal? YESX NO[j <br /> I Identify contractorperforming decontamination: <br /> Name S G 1 <br /> Address_2 Lv1 My1Z �(-!k\��u N� ap <br /> Phone No{ �-:) Q� 3 `� — 13 q-Z) - <br /> e. Describe method to be used for decontamination: <br /> IUC k'R _-) i ZM -\��l(6\ 2> C-I-\ 7 N�= <br /> (L Describe how rinsate material will be stored onsite prior to mantfesdng offsite: <br /> LL ) f: -2,L M c <br /> e. Rlnsate Hamer and permitted Treatment.Storage&Disposal Fit cWty: <br /> Hauler Name Hauler Registration# <br /> Address 2 P Ptd �,�y� city R\r N\/\()N�ztp g " O 1 <br /> Phone No.( <br /> Permitted Disposal Site C , <br /> 23 048 (Revised 10119198) Page 4 <br />