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1. (a)_ Is there a EHD contra,,c's and subcontractor's questionnaire o. :e or enclosed? YES NO [] <br /> (b) Is the current certificate of worker's compensation insurance on fie? YES NO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YE NO [] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on / <br /> (e) hazardous waste site in accordance with CCR Title 8? YES[fir( NO [] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES,[INO [] <br /> 3, Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> YES [] NO [I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA�YES[] <br /> NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [] <br /> NOA <br /> 6. If tank residual exists,identify transporting <br /> ghhazardous <br /> Awaste hauler: <br /> Name 07y//��C v`�i Haulier Registration#3.� <br /> Address �C7y 7 City G l l O� zip 1�7 S/3 j <br /> Phone#( —0 7 -Z 75 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES X NO [] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address 3 �� �" City Zip S� <br /> Phone No.( � <br /> C. Describe method e used for SLI tiO��%2K />� Tf/� � .✓ T <br /> Ci. 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 ,1�2� ��C'`��` j// 'tCG' Hauler Registration# `37� <br /> Address�D �O f3 `�� City Xz/// zip S/j/s <br /> Phone No. (_�5 , �F� 7 7�i Z-5- ��Sy© ZJ 2 �C ?r S <br /> Permitted Disposal Site2122 i r m17 <br /> -CG��SE i2o�J <br /> EH 23 046 (Revised 3/15/02) Page 4 <br /> gSZ6 � <br />