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1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YESM NO[] <br /> (b) Is the current certificate of worker's compensation insurance on tile? YES NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES M NO[J <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? YEW NO I] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N1A,J4, YES[] NO[J If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA!A YES[J NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] N0�R <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler: <br /> Name Hauler Registration# 53 <br /> Address 5 City Zip�� <br /> Phone# to � ,235- 139� <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address 5 City &ZIP CwJ <br /> Phone No <br /> C. Describe method to be used for decontamination: <br /> d. Describe how riusate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Ijaajer Registration r, <br /> Address J 5 -/�aCity Zip <br /> Phone No. IV 235 '/1�g3 <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 10119198) Page 4 <br />