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2, <br />3. <br />4. <br />S! <br />(a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation insurance on rile? <br />(c) Does the contractor possess a "Hazardous Substanc Removal Certification"? <br />(d) Has everyone on site, including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />Has a "Site Health & Safety Plan" for this job site been submitted? <br />YES [eNO[J <br />YES [VK NO [ I <br />YES W NO <br />YES [a' NO [ 1 <br />YES [r NO [ I <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A [t.l' YES [ I NO [ I If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ I YES[ I N% -r <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [tom NO ( J <br />INESr/GA77m) /s P2bSE71,7Y V yPEJ2 wAy <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name 64 51z, //U,//G Hauler Registration # . ell?— <br />Address P0' An,/ ! y City Zip 93-311b <br />Phone #( 0O-6 ) 337, - B7/0 <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [LK NO [ J <br />[em <br />C. <br />9 <br />e. <br />Identify contractor performing decontamination: <br />Name <br />Address 4",5:4 I -A A 4 City 5��4An Zip / S <br />Phone No.( M ) q5-&-02,64 <br />' <br />method to be used for <br />how rinsate material will be <br />r to <br />Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Abe (Ain /L Hauler Registration # ?Z//� Z— <br />Address F.U� 2(//% p _ city Q//` Zip <br />Phone No.�U /7J�3 Zy�r/tY�(� O 7/0 <br />i/ <br />Permitted Disposal Site C %VW 1 /,1G !�i'�� /Uyl�9� 2 TO <br />/20 <br />EH 23 046 (Revised 9/11/96) Page 4 <br />