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12/10/2002 09:39 2094683433 FIFTH FLOOR PAGE 09 <br /> s <br /> 1. (a) Is there a PHSEHD contractor's and subcontractor's questionualra on fue or enclosed? YES K Nall <br /> (b) Is the current certificate a1 worker's compensation Insurance an file? YES P. NO[] <br /> (c) Does the contractor possess a'Haasrdoa9 Substance Removal Certification"? YES K NO[] <br /> (d) Has everyone on site,Includingcranelbaekhoe operator,been aertilled <br /> to work an hazardous waste site In accordance with CCR Title 87 YESK NO]] <br /> 2. Has a Site Health&Safety Plan"for this Jab site been submitted? YESPik NO{j <br /> 3- Has applicant performing removal lathe City of Tracy obtained a'6tading end Excavation Pormlt"? <br /> N1A�J, YES I j NO(] if YES,Fermis 0 <br /> 4. Has the contractor obtained approval from the local fire department to perform tank euttlag7 NAKYE4]NO[1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piptog? of yes,please explain)YES 1 j N0X, <br /> 6. if tank residual exisss,identify transporting hazardous waste baulen , <br /> Name (int ,-,rS4 Lin fl��rriGnYot� BauderHegidbuddn! Cf> O Q$3652Z72 <br /> Address ��Ol QQft,1e, fZeFI.� City &Lt]rlC ztp�45t� <br /> Phoned( <br /> 7. Decontsmltlatioa Ptoeeduma: <br /> a. Will taak(s)and piping be decontaminated prior to removal? Y6S(Q NO[J <br /> b. Identify c <br /> on <br /> tractor performing decontamination_ <br /> Name V�1d X fSC,I L/1 v[f2n nrry 11 l"a� <br /> Address tftot rnao=v- 26• Clq &g,c.ta 21P <br /> Phone No.(_�?07 ) 710 (,(4jq <br /> C, Describe method to be used for decontamination: <br /> ! �dI �sn�e�2ts5��yaY �vtLr]o1�sSuae r,sGw�tc +-�aen7 <br /> d- Describe how r[nsate material WW be stored CORD Prior to manifesting 011311e: <br /> 0 UQLWyr] frOc4Qya SAMG Y)&,.4 &tl �y ) <br /> e. RinsateHauler and permltmdTreatment,Storage&DispoealFadUty: <br /> Hauler Name L) ,.rSR.` Lflulttt�/[/r1G1R•5� Vardar Registration CGi098365Z27� <br /> Address U J o f PaA*- 2D• . city /IIGI d_z1pq.y �l <br /> Muslin.( 707 1 ?`+7 669°1 <br /> Permitted Disposal Site <br /> 6H b C46 (Revised 0811 3M) Page 4 <br /> 12/10/02 TUI; 09: 43 [TX/RX NO 87091 008 <br />