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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [I NO [ J (b) Is the current certificate of worker's compensation insurance on file? YES (XJ NO [ J (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES (X[ NO [ (d) Has everyone on site, including craneibackhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES (XJ NO [ I 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES NO [ J 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A r I YES [ I NO ( I If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[XI YES[ I NOI 1 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ I NO [ 4 6. If tank residual exists, identify transporting hazardous waste hauler: Name ECI ERICKSON Hauler Registration # 0019 Address 255 PARR BLVD. City RICHMOND Zip 94801 Phone #( 51 0 ) 970-7460 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES [� NO ( I b. Identify contractor performing decontamination: Name ECI ERICKSON Address 255 PARR BLVD. City RICHMOND Zip 94801 Phone No.( 510 ) 970-7462 C. Describe method to be used for decontamination: PRODUCT LINES WILL BE FLUSHED WITH WATER, TANKS WILL BE TRIPLE RINSED AND RINSATE WILL BE PUMPED AND MANIFESTED d. Describe how rinsate material will be stored onsite prior to manifesting offsite: WILL BE TRANSPORTED SAME DAY AS PUMP OUT. e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name ECI ERICKSON Hauler Registration # 001 9 Address 255 PARR BLVD. City RICHMOND Zip 94801 Phone No.( 510 ) 970-7462 Permitted Disposal Site R O M I C 5/20 EH 23 046 (Revised 9/11/96) Page 4