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1. (a) Is there a PHS-EHD contractor's and subcontractoesquestiounalre on file or enclosed? YES K NO(] <br />(b) Is the current certificate of worker's compensation Insurance on file? YES M N0 [ 1 <br />(c) Does the contractor possess a " ous Substance Removal Certification"? YES 14 NO [ ] <br />(d) Has everyone on site, Including cranelbackhoo operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES14 NO [ 1 <br />2. Has a "Site Health & Safety Pian" for this job site been submitted? YES 14 NO (' <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA 4 YES [ J NO [ I It YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAAJ YES[ J NO[ J <br />5. Is there knowledge or evidence of leakage from the s) and/or pi (If yes, please explain) YES [ J NOAJ <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 s) and piping be decontaminated prior to removal? YES [ I NO;j <br />b. Identify contractor performing decontamination: <br />Name N ) r7 <br />T <br />10 <br />Phone No.( <br />C. Describe method to be used for decontamination: <br />d. Describe haw dusate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />M <br />Hauler Name N IHauler Registration # <br />City Zip. <br />Phone No. ( } <br />Permitted Disposal Site <br />EH 23 046 (Revised 10119M) Page 4 <br />