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2. <br />3. <br />4. <br />5. <br />21 <br />(a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES (k] NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on file? YES [K] NO [ ] <br />(c) Does the contractor possess a 'Hazardous Substance Removal Certification"? YES [ NO [ ] <br />Has a "Site Health & Safety Plan" for this job site been submitted? YES jX] NO [ ] <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A [)I YES [I NO [ ] If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YESPC] NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br />Unknown <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name Nor Cal Oil Hauler Registration # 417CAD 7255 <br />Address P.O. Box 645 Cit' Denair, CA Zip 95316 <br />Phone # ( gOp ) 332-8710 <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal'. YES ()I NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Oil Equipment Service <br />Address P.O. Box 950 City San Andreas Zip 95249 <br />Phone No.( 2D_9__) 754-1 808 <br />C. Describe method to be used for decontamination: <br />Pressure wash with hot water and cleaner. Pump dry via vacuum <br />- trueIt -,sa„d cEancpert to autharized. di SpSa l site. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />No storage <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Nor Cal Oil Hauler Registration 417 CAD 7255 <br />Address P.O. Box 645 City Denair, CA Zip 95316 <br />Phone No. ( 800 ) 332-8710 <br />Permitted Disposal Site Americlean Inc., Silver Springs, NV. #NVD982358483 <br />Page 4 <br />