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1. (a) Is there a EHD contractor's an�pwjbcontractor's questionnaire on file or enclosed'? YES[v]' NO [J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES[r] NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"7 YES[L]` NO[] <br /> (d) Has everyone on site, including crane/backhoe operator,been certified to work on <br /> 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? YES[] NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"'? <br /> N/A j] YES [] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting'?NA[]YES[] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES [] NO[] <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Hauler Registration# <br /> Address City_ Zip <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal'? YES[f]' NO[] <br /> b. Identify contractor performing decontamination: <br /> i r <br /> Name �y. �,, '�� ti'x ce-e_xet.' <br /> Address a(Jr, f. . ,✓ r r City ���t sJ : 1-_A Zip <-- —r <br /> Phone Notr-c-! <br /> C. Describe method to be used for decontamination: } <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> r r <br /> Io <br /> 1-0 1. 4c <br /> C. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name ,, :���_�et� �w�+ ��-g'^*� " Hauler Registration# <br /> Address ( ` `t i-l city JLh t�e�-; f Ky r_Zip '4�, <br /> Phone No,U �'L�>4 ` fU t <br /> Permitted Disposal Site r�h_ t� N>�'�$�` t �- '' ' <br /> EH 23 046 (Revised 07/31/09) 4 <br />