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1. (a) Is there a PHS-EF D contractor's questionnaire on file or enclosed? YES X NO ( J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES DQ NO [ J <br /> (c) Does the contractor possess a "Haardoas Substance Removal Certification"'. YES NO ( J <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 pQ NO ( J <br /> 2. Has a -Site Health & Safety Plan" for this job site been submitted? YES NO [ J <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A M YES [ J NO [ J If YES, Permit <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAX YES( J NO( J <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name 97Zi Cie-so <br /> IJ G. Hauler Registration # 40 1 <br /> Address 25S PAe.fL e 1L v D City Zip !¢801 <br /> Phone R ) �3S `3q3 <br /> 7. Decontamination Procedures: <br /> a, Will tank(s) and piping be decontaminated prior to removal? YES NO ( J <br /> b. Identify contractor performing decontamination: <br /> Name WnC.T�w�l ZLslnl "Xa L. <br /> Address City W .SAC /v Zip <br /> X56 9 <br /> Phone No.( <br /> C. Describe method to be used for decontamination: <br /> TP-L Pc,� ��►5 <br /> d. Describe how rinsate <br /> material o onsite prior tmanifesting offsite: <br /> e£ <br /> W!c- - TaS� a <br /> 1FJ :517-F <br /> Di2Ez7c.q Wro ui; P ZW Gr <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name l GKSo� 1�G• Hauler Regis=tion # <br /> Address <br /> 25S" f_ 6LVO City f=►U,{MDn�D Zip <br /> PhoneNo- L1510 <br /> Permitted Disposal Site Zss (A2'2— 6L,\) a IGK�►+oN� <br /> 5/20 <br /> Psge 4 <br /> EH 23 046 (Revised 9/11/96) <br />