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12/18/98 FRI 09:30 FAX 5106096304 <br />* .W <br />REL DESIGN GROUP <br />L (a) Is there a PH&EHD contractor's and subconhactar s questionnaire on file or enclosed? <br />(h) Is the current eerdHcate of marker's compensation insurance on file? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(d) Has everyone on site, Including eranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCE Title 8? <br />2 Has a "Site Health & Safety Plan" for this job site been submitted? <br />--, RHL PETALUMA <br />YESM NO[] <br />YESM NO[] <br />YES (Kj NO j ] <br />3. Hasa plicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIAX YES [ ] NO j j If YES, Permit # <br />YES14 NO[] <br />YES[] NOM <br />4. Has the contractor obtained approval from the local Ore department to perform tank cmdug? NAN YES[ I NO[ I <br />5 is there knowledge or evidence of leakage from the tanks) andlor piping? (If yes, please explain) YES I ] NO [ ] <br />G_ It tank residual exists, Identity transporting Imzardons waste haaler. <br />Name <br />Crosby 4 <br />D\IE.R-'TotJ <br />Hauler Registration# <br />072S <br />Address <br />814 3o <br />AmckLg S -C, <br />City Cak.lar..0 Zip <br />9 r{(o21 <br />Phone # ( 'S 10 ) (0 -6 3- o <br />7. Decontamination Procedures: <br />a. Will tanks) and piping he decontaminated prior to removal? YES D( NO [ ] <br />b. Identify contractor performing decontamination <br />Name C! oP5�1 $ O\)ER.To� <br />Address Nnlelra SY CRY Orlk[ar%_zip 94621 <br />Phone No.{ SID ) (a'3 3- 0'33 (- <br />C. Describe method to <br />I. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />no+5T-or e0 <br />e. Rinsate Hauler and permitted Treatment. Storage & Disposal Facility <br />Hauler Name C Y OS bti Over Or Hauler Registration # 0 C12S <br />Address S<Z a6W2 <br />City <br />Phone No. ) see a bw-e <br />Permitted Disposal Site i(OW W, l�iti $t L066 &aCl CA 90813 <br />EH 22 046 (Revised 10119198) Page 4 <br />Z005 <br />