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0 <br />• <br />1. (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? <br />NO ❑ <br />(b) is the current certificate of workers compensation insurance on file? YESV <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />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? YESIK <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES, <br />3. Has applicant performing removal in the City of Tracy obtained a <br />"Grading and Excavation Permit"? N/A YES ❑ <br />If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to <br />perform tank cutting? 11)6 -W/1 r nAl he N/A/W YES ❑ <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? <br />(If yes, please explain) YES ❑ <br />YES)Z <br />NO ❑ <br />YES <br />NO ❑ <br />NO ❑T/VW6 <br />NO ❑ <br />NO ❑ <br />6. If tank residual exists, identify transporting hazardous waste hauler: �✓ �p 3°(bS <br />Name PAI l� , � v far �`�nJ_- Hauler Registration #A At, i -n <br />Address% ��agas Ave. City_ ��' 2) Zip r%D <br />Phone # <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES, NO 5( <br />b. Identify contractor performing decontamination: <br />C. <br />Name <br />Address_ <br />Phone # I <br />Describe method to be used for decontamination: <br />City_ <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />on <br />e. Rinsate Hauler and .permitted Treatment, Storage & Disposal Facility: <br />Hauler Name—_- _ __,_� _ Hauler Registration <br />Address city, Zip ,- <br />Phone # <br />EH 23 046 (Revised 10/16/03) Page 4 <br />