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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[� 0[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES(l]�NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[eNO[] <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[q/'NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES 11NO[] <br /> 3. Hasap cant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA YES I] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAKftS(]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes.please explain)YES[] NO <br /> 6. If tank residual exists,identify transportiigahazardous waste hauler. !� <br /> Name Amer 'MI) L� e! Hauler Registration 11 Cf3L (�O0/a %�-/ <br /> Address �73� l:ee�' City TUr/Ccn Zip 7J �, <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES(c)-IO(] <br /> b. Identify contractor performing decontamination: <br /> Name pmdy, - Tn <br /> Addressl a q �+' V1 City �I C►'� Zip <br /> Phone Na(Nq ) <br /> c. Describe method to be used for decontamination: <br /> -flip/f, <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> in <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposaly: <br /> / Facilit , <br /> Hauler Name &121 CM 51����� /%T�U Hauler Registration# <br /> Address pW6 City Zip 9�538� <br /> Phone No. <br /> Permitted Disposal Site �LC� C/l ��/ V— <br /> EH 23 046 (Revised 10119198) Page 4 <br />