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08 <br /> 1. a) is there a PHS-EHD owitractor's questionnaire dot file or enclosed? YES*Q NO( J <br /> b) Is the current certificate of workers civil pe lisathm insurance on file? YES NO[ J <br /> C) Docs die contractor possess a "Hazardous Substance Removal Certification"? YES (}(j NO[ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES NO( <br /> 3. Has applicant perforating removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A(X J YES ( ) NO( J If YES. Permit# <br /> 4. Hws the contractor oNained approval fnvu tic Itx al fire dellart trent to perform tank cutting? <br /> NA(ti YES ( ] NO[ ] <br /> S. Is there knowledge or evidence of leakage from the tank(s)and/or piping? YES ( j NO( J <br /> (if yes.please explain) <br /> 6. if tank residual exists.identify tnutsix)rting hazardous waste hauler: <br /> Name <br /> 1,1(,KtioN�S NL Hauler Registration tf0019 <br /> Address _szCS 9! AfL^v.�L�J® City_lUJm lj Zip <br /> Pho ne No. (S10 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES [ ] NO <br /> b. Identify contrac for performing deet intantination: <br /> Name <br /> Adds City Zip <br /> Phone No. ( ) <br /> c. Describe method to be used for decontamination: u f s <br /> d. Describe how rinsate material will be Mored on-site prior to manifesting off-site: <br /> e. Rinsate Hauler and permitted Treatment.Storage&Disposal Facility: <br /> Hauler Nime A Hauler Registration # <br /> Address City _ Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> 4 <br /> e <br />