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Ne <br />1. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES Vi NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on rile? YES NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES NO [ ] <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? YES [Q 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 />N/A"jd YES I I NO [ I If YES, Permit 9 Upon Approval <br />4. fins the contractor obtained approval from the local fire department to perform tank cutting? NAM YES[ ] NOI 1 <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name Nor Cal Waste Oil Haulers Hauler Registration # CAD 982417255 <br />Adrtrnas P.O Box 645 City Denair, CA Zip 95316 <br />Phone 1 ( 800 ) 332-8710 <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES $] NO I ] <br />b. Identify contractor performing decontamination: <br />Name Jim Thorpe Oil, Inc. <br />Address P.O. Dox 357 City Lodi Zip 95241-0357 <br />Phone No.( 209 ) 368-6175 <br />c. Describemmtethod to be used for decont mina on: <br />Tank(sl and piping will be ripie rinsed with a biodegradable soap solution <br />d. Describe how rinsa(e material will be st r d onsi ri r t ani tin of ite: <br />Hinsate will either be remove eirom ehI, ian�C�y ��ie has e oil hauler while <br />the tank an(] I ines are being rinsed or stored in labled and sealed drums_ <br />on site until they can be removed to a proper disposal facility. <br />e. Ainsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Same as #6 Hauler Registration # <br />City <br />Phone No. <br />Permitted Disposal Site Americlean Inc 2570 Almond Dr Silver Springs, Nv. 89429 <br />5/20 <br />EH 23 046 (Revised 9/11/96) Page 4 <br />