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1. (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YENO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YE O O[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES 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? YE NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YE NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/ YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N. YES[] NO[] <br /> 5. Is t e knowledge or evidence of leakage Lo the tank(s) and/or pin (If yes,please explain)YE NO[] <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name /C4 Hauler Registration# <br /> Address city ' L / zip 5 l <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YE NO[] <br /> b. Identify contractor performing decontamination: <br /> Name —767/0—/T& <br /> Address city Zip 9 0X 35`7 <br /> Phone No. `_ <br /> C. Describe method to be used for decontamination: <br /> Of <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> , c OCAC <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name f Hauler Registration# 0241 <br /> lei <br /> Address J City Zip <br /> Phone No.( Z / Z 7/ <br /> Permitted Disposal Site ti el �C <br /> e)lIF I7-c C'9- <br /> ® r <br /> EH 23 046 (Revised 07/31/09) 4 <br />