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6. If tank residual exists, identify transporting hazardous waste hauler: Name Hauler Registration # Address City Zip - Phone # ( 1 Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES [WINO [ ] b. Identify contractor performing decontamination: Name _Q. e /� _ et ., _ ...II,— Address Phone C. Describe method to be used for decontamination.- d. econtamination:d. Describe how rinsate material will be stored onsite prior to city Zip 9 S-3 6� 6 e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: f Hauler Name /r .e C�„ ��.. �IvU it a6 Hauler Registration# Addressyo, Un( .La(U9 City Zip Phone No. ( #'�- U 0 Permitted Disposal Site U t lam» 11r11rn ya e EH 23 046 (Revised 07/31/09) 1. (a) Is there a EHD contractor subcontractor's questionnaire on file or enclosed` (b) Is the current certificate of worker's compensation insurance i YES P7 NO [ ] on file? (c) Does the contractor possess a "Hazardous Substance Removal Certification"? (d) Has YES [� NO [ ] YES [GK NO [ ] everyone on site, including crane/backhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YESW NO [ ] 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES K'NO [ ] 3. Has I icant Performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A YES [ ] NO [ ] If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA BS[ ] NO[ ] , 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO 6. If tank residual exists, identify transporting hazardous waste hauler: Name Hauler Registration # Address City Zip - Phone # ( 1 Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES [WINO [ ] b. Identify contractor performing decontamination: Name _Q. e /� _ et ., _ ...II,— Address Phone C. Describe method to be used for decontamination.- d. econtamination:d. Describe how rinsate material will be stored onsite prior to city Zip 9 S-3 6� 6 e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: f Hauler Name /r .e C�„ ��.. �IvU it a6 Hauler Registration# Addressyo, Un( .La(U9 City Zip Phone No. ( #'�- U 0 Permitted Disposal Site U t lam» 11r11rn ya e EH 23 046 (Revised 07/31/09)