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I <br /> (a) is there a PHS EHD contractor's and subcontractor's questionnaire on file or enclosed? �5 NO[ j <br /> (b) is the current certificate of worker's compensation insurance on tile? [j (] ItA <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESV NO(j <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified YES t„/No E 1 <br /> to work on hazardous waste site in accordance with CGR Title 87 <br /> 2 Has a"Site Health&Safety Plan" for this job site been submitted? YES(-(NO(j <br /> 3 Hasa licant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA( YES(j NO[) It YES, PErmlt# <br /> 4 Has the contractor obtained approval from the local fire department to perform tank cutting?NA.�YES(j NO(] <br /> S Is there knowledge or evidence of leakage from the tank(s)andlor piping? (it yes,please explain)YES]] NO(rj� <br /> ] 6 If tank residual exists,identify transporting hazardous waste hauler <br /> Name 1 -' Hauler Registration!♦ <br /> Ir <br /> Address y City zip � <br /> Phone <br /> 07 Decontamination Procedures <br /> YES{rj`N D <br /> a Will tank(s)and piping be decontaminated prior to removal? <br /> b Identlfy contractor performing decontamination <br /> Name 71E(�* �^ I5 Zlj <br /> Address i b ba' aL1 t� _City. _ p D 1 <br /> Phone No aFL—i <br /> c Describe method to be used for i co tamin tion �. <br /> d Describe how Ansate material will be stored onsite pylar to manifesting ofislte �t <br /> LL 1P UAYW LI? <br /> } a Rinsate Hauler and permitted Treatment,Storage&Disposal Facility <br /> Hauler Name 1 �-- Hauler Registration# <br /> Address 6 � City <br /> .� <br /> 1 Phone No 5 <br /> Permitted Disposal Site �,Tsi P&� liw� <br /> E9 23 046 (Revised 08113199) Page 4 <br />