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11 <br />r <br />1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES [ ] NO ( ] <br />(b) Is the current certificate of worker's compensation insurance an file? YES [ ] NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [ ] NO [ ] <br />(d) Has everyone on site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with CCR Title 8? YES [ ] NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ ] NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA ( ] YES [ ] NO [ ] It YES, Permit N <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ J YES( ] NO(1 <br />a. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES [ ] NO [ J <br />6. If tank residual exists. Identify transporting hazardous waste hauler. <br />Name Hauler Registration A <br />Address City ZIP <br />Phoned( ) <br />7. Decontamination Procedures: <br />a. will tank(s) and piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name <br />Address city ZIP <br />Phone No( j <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility <br />Hauler Name Hauler Registration rf <br />Address City Zip <br />Phone No. <br />Permitted Disposal <br />EH 23 046 (Revised 10119198) <br />Page 4 <br />