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'i <br /> 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[) NOIJ 141p,-/ <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YESV NO[[ <br /> ( (d) Has everyone on site,including cranelbackhoe operator,been certified � f <br /> to work on hazardous waste site In accordance with CCR Title 87 YES M NO[I <br /> 2 Has a"Site Health&Safety Plan" for this job site been submitted? YES[-(NO[) <br /> 3 Hasiicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N!Aa YES11 NO[[ 1[YES, Permit# <br /> ' 4 Has the contractor obtained approval from the local fire department to perform tank cutting?NA�YES(1 NO[[ <br /> 5 is there knowledge or evidence of leakage from the tank(s)aadlor piping? (1[yes,please explain)YES[J NO[� <br /> 1 <br /> 6 It tank residual exists,identity transporting hazardous waste hauler 1 <br /> Name ` t*m O+ LU1 --Hauler Registration d <br /> Address�b 1p� �� City. zip Ij3r2 <br /> Phone NI <br /> 7 Decontamination Procedures <br /> a Will tanks)and piping be decontaminated prior to removal? YES{�NO[j <br /> 1 <br /> b Identity contractor performing decontamination <br /> Name ` <br /> Address City Zip ` <br /> Phone No <br /> ' c Describe method to be used for deco tarnin tion l <br /> 1 " <br /> d Describe how rinsate material will be stored anslte prior to manifesting oftslte <br /> LLLAIMpa nm� <br /> �£�arl t rstr <br /> e Rinsate Hauler and permitted TreatmenC Stdrage&Disposal Facility - - - — — -- — _ — - -- -- <br /> Hauler blame Hauler Registration <br /> Address ���� T'gr''� � �� _—cid ! P <br /> Phone No Lyn--) <br /> t Permitted Disposal Site <br /> D'Ul��'i�1 <br /> EH 23 046 (Revised 08113199) Page 4 <br />