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\. 1-110 <br /> 1. (a) Is there a 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[I NO <br /> IJ <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESV 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[] NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YESX NO(] <br /> 3. Has ap licant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A YFS [J NO[] Tf YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAKYES[J NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NOAJ <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Hauler Registration# <br /> Address CityZip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[] NOX <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address Cit} Zip <br /> Phone No.( ) <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# <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 3/15/02) Page 4 , <br />