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' 1 (a) Is there a EHD contractor s and subcontractor's questionnaire on file or enclosed YES NO (] <br /> (b) Is the current certificate of worker's compensation insurance on file9 YES NO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESkJ NO [I <br /> (d) Has everyone on site, including cranelbackhoe operator, been certified to work on <br /> (e) hazardous waste site in accordance with CCR Title 8' YES [ NO [] <br /> 2 Has a"Site Health &Safety Plan"for this fob site been submitted? YES NO [] <br /> 3 Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit'? <br /> NIAIq. YES [I NO [] If YES, Permit# <br /> 4 Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] <br /> NO[] <br /> 5 Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES <br /> NO [] <br /> l catcn t �fo re_ el 41,14 <br /> 6 If tank residual exists, identify transporting hazardous waste hauler <br /> Name I-awics enviroeyk)"J-1 Se-f,LIcc-Gs Hauler Registration# 5/K <br /> ' Address City y1t� _ ua onFo Zip 95651 <br /> Phone# <br /> 7 Decontarrunation Procedures <br /> a Will tank(s) and piping be decontaminated prior to removal? YES K NO [] <br /> b Identify contractor performing decontamination <br /> Name ron ,ria vf4L f r7 e- r In Co. �rcuc�ln <br /> Address a( Pa rtc e✓i iffw Qr r d t-. _City C.4n1w- Zip s <br /> Phone No ( 7"I L'f ) 66 7-2-300 <br /> c Describe method to be used for decontamination <br /> -,tri/p le_ l'rrrs-r- <br /> ' d Describe how rinsate material will be stored onsite prior to manifesting offsite <br /> (/a.G V Jn? t-r 0(:-lc <br /> ' e Rinsate Hauler and perp-utted Treatment, Storage &Disposal Facility <br /> Hauler Name^P a n10S _ 5�rLltce5 Hauler Registration# 519' <br /> Address City .iAMsf &crrmoaly Zip gS6S <br /> Phone No <br /> Permitted Disposal Site m End Q <br /> EH 23 046 Revised 3115/02) Page 4 <br />