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1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YEV 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"? YESM NO[] <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,[ NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YEqM NO(] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A-A, YES(] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NIA YES[]NO[NJ <br /> ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES(] N0�l <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name Hauler Registration# 5 <br /> 33 <br /> Address 5CityZip�� <br /> Phone# o �,235- 139 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESM NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address 5 City 4 J-Zip <br /> Phone No 0 <br /> C. Describe method to be used for decontamination: <br /> TPI)OLF eJIL� <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> �,A6&-ZLLl?ZS <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility <br /> Hauler Name er Registration r <br /> Address 55 City6a,, Zip Uv/ <br /> Phone No. U /2 /3 <br /> Permitted Disposal Site <br /> 0 <br /> EH 23 046 (Revised 10/19/98) Page 4 <br />