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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 on file? YES V NO[] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES VNO [ ] <br />(d) Has everyone on site, including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES V NO I ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES J NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA [ ] YES I/ NO [ I If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAI ] YES[ ] NO[G]/ <br />5. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES VNO [ ) <br />Dc)c_U rAE T s— U ,A e "f ;�— U 0-Z <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name V LF— 0- Q F Fri Hauler Registration # C9 T <br />�r <br />Address al 1, T 6 VAy City Q A A 4 Zip O_ <br />Phone # W <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [q' -'NO [ ] <br />b. Identify contractor performing decontamination: <br />Name b 6 f` eij r <br />Address jD, I� C )off' cityz,-,, c3ww Czip <br />PhoneNotlDr1 1 �0, e— / -�I/, 7y <br />C. Describe method to be used for decontamination: <br />71 �1r �ttiiS i_l�1b \ 11 [ tC7-S�1\/2 <br />d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name /_/ i?c Hauler Registration # <br />Address 6, rq i T \/ city t-,) A up, 14� Zip 9 1�-f S"'C O <br />Phone No. <br />Permitted Disposal Site <br />EH 23 046 (Revised 10119198) Page 4 <br />