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1. (a) <br />Is there a PHS-EHD contractor's questionnaire on file or enclosed? <br />YES p(j <br />NO <br />(b) <br />Is the current certificate of worker's compensation insurance on File? <br />YES <br />NO J J <br />(c) <br />Does the contractor possess a "Hazardous Substance Removal Certification'? <br />YES <br />NO J <br />(d) <br />Has everyone on site, Including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />YES QQ <br />NO J J <br />2. Has a "Site Health & Safely Plan" for this Job site been submitted? <br />YES <br />NO J J <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A K YES I J NO I I If YES, Permit # upon approval <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAI I YESI I NON <br />5. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES I I NON <br />6. If tank residual exists, Identify transporting hazardous waste hauler: <br />Name Nor Cal Waste Oil Haulers Hauler Registration N CAD 982417255 <br />Address P. 0. Box 645 City Denair, CA Zip 95316 <br />Phone #( 800 1 332-8710 <br />7. Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to removal? YES NO I J <br />b. Identify contractor performing decontamination: <br />Name Jim Thorpe Oil, Inc. <br />Address P. 0. Box 357 City Lodi Zip 95241-0357 <br />Phone No.( 209) 368-6175 <br />C. Describe method to be used for decontamination: <br />Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Rinsate will bither be removed from the tank by the waste oil hauler while <br />the tank and lines 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. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name same as #6 Hauler Registration # <br />Address City Zip <br />Phone No. <br />Permitted Disposal site Americlean, Inc. 2570 Almond Dr., Silver Springs, NV 89429 <br />5/20 <br />Elf 23 046 (Revised 9/11/96) Page 4 <br />