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1. (a) Is there a PHS-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 file? YES[] NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES V NO[] <br /> `~ (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 87 YES NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> ,r NIA[.]/ YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA�YES[]NO[] <br /> 5. Is there knowledge or.evidence of leakage from the tanks)andlor piping? (If yes,please explain)YES[] NO[� <br /> 6. If tank residual exists,Identify transporting <br /> `h1azardous waste hauler- <br /> Name &&� k tAo ,�� y l- Hauler Registration# <br /> Address l b 1 D'� City ZIP 1�� <br /> .� <br /> Phonefl <br /> ( <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES�NO[] <br /> b. Identify contractor performing <br /> Zdecontamination: <br /> Name DrEL7Er- n19��kcl� <br /> `r Address U CSL ' City QW��-� Zip <br /> Phone No.(0� 94 V 51 <br /> .r <br /> C. Describe method to be used for deco tamin tion: <br /> CC 6 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> UJ LL <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name kME-V-% CA-Y\, Hauler Registration# _ <br /> .r Address.1 61�� � � City ML41 ) (A` Zip S5:31 S <br /> Phone No.( M <br /> Permitted Disposal Slte-V GM STV�,IL., tbw J LE76) <br /> EH 23 046 (Revised 08113199) Page 4 <br />