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1. (a) Is there a PHSSEHD contractor's and subcontractor's questionnaire on file or enclosed? YESr�/NO(] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES 9 NO[I <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES eNO[I <br /> (d) Has everyone on site,Including craneihackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 87 YES W NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES{]-No[I <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA W YES[] NO[) If YES, Permit 4 ,,gy�pp <br /> 4. Has the contractor obtained approval <br /> from the local fire department to perform tank cutting?Ni0i�P]N <br /> 0 <br /> ease explain)YES NO[] <br /> 5. Is there knowledge or evidence of leakage from the s and/or piping?. (1f ) <br /> �Irl.✓�G1 �� �� <br /> 6. If tank residual exists.Identify transporting hazardous waste <br /> waste hauler. <br /> RUAaA&4 i,Wer Registration#3 <br /> Address f0 (SC)c sy C1ty i zip 95-zlc <br /> Phone,#( QOu <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? <br /> b. Identify contractor performing decontamination: <br /> Name«C-n> ..5,�/�� <br /> Address430 $ /Yw _ Nouw—tl gam- City S� Zip <br /> Phone No �-O' �1� Y/ ,',737 <br /> c. Desc�r"ethod to be used for decontamination <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Haulerandpermitted Treatment,Storage&Disposal Faciliy: <br /> tn <br /> HaulerName�iaelL!C>Q 1� 1f�7 rJVI�G[}uF� erRegistratIan# <br /> Address6GXy'LkO <br /> city\ zip qS3 <br /> Phoneme,( gUu 1 � 32 ��f6cfs <br /> Permitted Disposal SiteL - <br /> 1?cc)a So• y <br /> EH 23 046 (Revised 10119198) Page Q Z3 <br /> � r P� <br />