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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES N NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES N NO[[ <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES N NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES14 NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YESk] NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAA YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the ocal fire department o perform tank cutting?NA[jYES[]NO[] <br /> 5. Is there knowledge nr no+dunne n f leakage from the tank(s)andlor piping? of yes,please explain)YES[] NOX <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name American Valley Waste Oil Haule gaulerReglstradon# CAL 000827878 <br /> / Address P.O. Box City Delhi , CA yip 95315 <br /> Phone#( 800 ) 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[K NO[ <br /> b. Identify contractor performing decontamination <br /> Name Jim Thorpe Oil , Inc . <br /> Address P.O. Box 357 City Lodi, CA yip 95241-0357 <br /> Phone No.( 209 ] 368-6175 <br /> C <br /> . method to be used for decontamination <br /> (s) will be triple rinsed with a biode�radeable soap Solution <br /> ot water. The associated lines will be done in a similar way. <br /> how rinsate material will be stored onsite prior to manifesting offsite: <br /> ate will either be removed from the tank and lines as they are <br /> rincar3 by the + h st r'9d n Ee3' e� - l-ahled until <br /> can be pumped out . <br /> Hauler and permitted Treatment,Storage&Disposal Facility.ameAmerican Valley W.O. Haulers Hauler Registration# CAL 000827878 <br /> Address P.O. Box 340 City Delhi , CA Zip 95315 <br /> PhoneNo.( 800 ) 332-8710 <br /> Permitted Disposal Site Americlean Inc 2570 Almond Dr. , Silver Springs , NV <br /> or other approved facility. <br /> EH 23 046 (Revised 08113199) Page 4 <br />