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P. S <br /> 1. (a) Is there a PHS•EHD contractor's and subcontractor's Questionnaire on Ille or enclosed? YES(j NO(j <br /> (b) Is the current certificate of worker's compensation Insurance on tile? YES(j NO�( <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certificatinn"? YES NO(j <br /> (d) Has everyone on site,Including crane/backhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 87 YES NO(j <br /> XN <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YESV NO(j <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA I I YES I j NOX If YES. Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAI I YES[j Noq$ro <br /> a. is there knowledge or evidence of leakage from the tanks)and/or piping? (1f yes,please explain)YES(j Nov <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Nae C ®� Y ®V IF12 O <br /> Maine 11� Hauler Registration# <br /> Address M CL 1h/• city—6-*iLj/b zip�-� <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES NO(j <br /> b. Identify contractor performing decontamination: <br /> Name -A TOIL <br /> Address tt fi ri Ch/r/ Zip_yy 6 <br /> Phone No.-.2o ) b 13Z— (o3 6 <br /> e. Describe method to be used for decontamination: <br /> d. Deseli be how tinsels material will be stored onsite priggr to manifesting offsite- <br /> WILL Mnt be- <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Faeflity: <br /> Hauler Name D.S vCt-,0- Hauler Registration# Z� <br /> Address3® 'r- ' city /�} �'b�Zip__ 21 <br /> Phone No.( Lo 1 6 � ® 33 4 <br /> Permitted Disposal Site LOX11 � /� 0 AIAOC <br /> EH 23 046 (Revised 08113199) Page 4 <br />