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%w.. <br /> I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [)Q NO [ I <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [i NO [ j <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES ( NO [ i <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 1)4 NO I I <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [�, NO [ <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [XJ YES I I NO [ I If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA(} YES[ j NO[ j <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [A NO [ J <br /> Soil samples collected adjacent the USTs detected TPH-h, at <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name Non r•rr ni I Hauler Registration #__2_4j_2_ <br /> Address P.O. Box 64 City nenair ZiP _9&,�� <br /> Phone # ( 209 ) 667-6692 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [)d NO <br /> b. Identify contractor performing decontamination: <br /> Name Advanced GeoEnvironmental Inc. <br /> Address 1803 W. March Lane #A City Stockton Zip g59n7 <br /> Phone No.( 209 ) 956-0264 <br /> C. Describe method to be used for decontamination: <br /> Steam clean inside of underground stnraae tank fnr apnrnr <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinsate will he lallmnad nut of rtcT hir a rQqi Rto oa ;4te <br /> hauler. <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Nc)r-ra I ni 1 Hauler Registration # 2412 <br /> _ <br /> Address P-0- Rnx 64 City —oma— ZiP--9-�— <br /> Phone No. ( 2 n 9 ) 667-6692 <br /> Permitted Disposal Site Americlean, Inc. (permit # NVD982358483 ) <br /> 5/20 <br /> EH 23 046 (Revised 9/)1196) Page 4 <br />