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1. (a) is there a PHS-ERD contractor's and subcontractor's questionnaire on file or enclosed? YESK NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YESR NO() <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESy NO(] <br /> (d) Has everyone on site,Including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YESW NO(] <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YE_lX <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Szcavatfon Permit"? <br /> NIA DC YES[) NO[) If YES, Permit B <br /> 4. Hasthecontractor obtained approval from the local fire department to perform tank cutting?NIKYES[1 NOI1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NOK <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler: , <br /> NamdQ/✓I d`�5rd/nnAtey�d��PUi'. a HaalerReslstratwn f-V9 /y�_ <br /> Address1�jr<�,")Nr W. Cltya�8Ip— e <br /> Phone N <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES ( NO[J <br /> b. Identify contractor performing decontamination: <br /> Name n��y�yJr�l��/Yin/'lliia k�� Yglyl"At 1��7c/1��,. �����0� /�—'J1'. �a� City 7dp ;rp <br /> //Y,f(!V _ <br /> Address <br /> PhoneNo.jX )R3 —�'75k <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material win he stored onsite prior toaalte ling offsite• <br /> � I II ht° ✓Gir .I r dva�, . orf CIE nII`IJk' G� <br /> 81 6 1. n r AQ /1221 <br /> e. RinsateHauler and permlttedTreatment Storage&Disposal Facility., <br /> HaulerNam�eD1/1�]�jJi(IPC'H1an(lerRegistrationi <br /> Address J� Av l�.l Clty�,V� AGI' CrQrn�1>�Lip ��9/ <br /> Phone No. <br /> Permitted Disposal Siteate,- /i ll• <br /> I EH 23 046 (Revised 08113!99) Page 4 <br />