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1 . (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES (-rNO [ J <br /> (b) Is the current certificate of worker's compensation insurance an file? YES k40 40 [ ( <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 { 1 NO [ ] <br /> 2. Has a " Site Health & Safety Plan" for this job site been submitted? YES .[-)' NO [ ] <br /> 3. Has ap Ucant performing removal in the City of Tracy obtained a " Grading and Excavation Permit" ? <br /> NIA [vr YES ( ] NO [ J If YES, Permit # <br /> 4. Has the contractor obtained approval from the local the department to perform tank cutting? NA[JIF4 ] NO[ 1 <br /> 6. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES [ J NO [� <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name G:C�Z Hauler Registration # /s 3 <br /> Address 2SS pp?:F= Cy1> CityRtc-FW-VfkD Zipyt/00 <br /> Phone # (S/ � <br /> 7. Decontamination Procedures: <br /> a, will tank(s) and piping be decontaminated prior to removal? YES [4�'40 [ I <br /> b. Identify contractor performing decontamination: <br /> NameticL.. 5r�rra i �Q Co Z�( <br /> Address o B /�o . Lldlc)6( <S- T. City `rrmAr—� Zip Q.S'ZOS <br /> Phone No( ZOQ <br /> c. Describe <br /> /glethod to be used for decontamination: <br /> /`/ I4 QEwA Pf/- QCE4 Ac4 � — TRL G6 � TL}nt�ly� STT <br /> d. Describe how imatQa material will be stored onsite prior to manifesting offsite: <br /> e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facillty: <br /> Hauler Name A rNrp+ ,t7A�j V-pz 044a%mLHaulerRegistration #S 9 VY <br /> Address.T � t5 ?c 3tfU city tF \ Zlp�a/ � <br /> Phone No, 2 3 Z — g6KS <br /> Permitted Disposal Site T r,, bt L� 7L:rtc <br /> Soro � 1�ctJFx �t�s G4 • �lSo Z3 <br /> EH 23 046 (Revised 10119198) Page 4 �� oc- c zfs2? ©,4' <br /> Pu-IF S Z-598 - 7 7 <br />