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t <br /> t <br /> 7 <br /> .i. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[+ NO(] <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES VNO[] RenCwal Cref�• <br /> (c) Does the contractor possess a"Hazard Substance Removal Certitication"? YES( NO[] <br /> (d) Has everyone on site,including crauelbackhoe operator,been certified To fo<(rW <br /> to work on hazardous waste site In accordance with CCR Title 8? YES INO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted?Or P It tDI FP;Aq W .S WINO[] <br /> S. Has ap cant performing removal In the City of Tracy obtained a"Grading and vatllon Permit"? <br /> NIA YES[] NO[] If YES, Permit p <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N S[[NO[[ <br /> 5. Is there knowledge or evidence of leakage from the s)and/or piping? (If yes,pleasealn)YES NO[] <br /> 14,6 el s I I dlNO V,5; o eaplf � a Es <br /> -F , T'4411 COW <br /> rnsxv-4— i <br /> 6. If tank residual exists,identify transporting hazardous <br /> �gwastte(®haul/e1r. <br /> Name ', G0.1'1 Y Q.t�ey WQ 7ty i/l ' Hauler Registration it <br /> Address �.(�, p� 3 D city k f Zip 9531 S <br /> Phone d( SO 0 7�j 2.- <br /> 7. <br /> .7. Decontamination Procedures: <br /> j� a. Will tank(s)and piping be decontaminated prior to removal? YES(,]/NO[j <br /> b. Identify contractor performing decontamination: <br /> Name dya.t- Caen cf']wo n m f Th L a <br /> i <br /> Address 8 �� S o. RA. city Zip `7 7 <br /> Phone No4 4 b7-*—)0(o <br /> C. Describe method to be used for decontamination: <br /> r W <br /> d. Describe bovq msate material <br /> be stored onsit print to m estix} offsite: <br /> d 'S� i MW1C <br /> a <br /> e. Rinsate Hauler and permWd Treatment Storage&Disposal Facility: <br /> Hauler Name i c c l�1 VAJ( Hauler Re tlon xi -37 <br /> 44 <br /> Address '• b. ® 3L 3`/ City t Zip <br /> Phoue llo.LU V ) -- <br /> Permitted Disposal Site IVe,66 101 1 e irA-i1 S <br /> EH 23 046 (Revised 08113199) Page 4 <br />