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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on Elle or enclosed? YES NO [ J <br />(b) Is the current certificate of worker's compensation Insurance on file? YES NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES NO [ ] <br />(d) Has everyone on site, Including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with CCR Title 87 YES)( NO [ j <br />Z. Has a "Site Health & Safety Plan" for this Job site been sabmltted7 YES]kNO ( ] <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/% YES [ ] NO ( j If YES, Permit N <br />4. Has the contractor obtained approval from the local fin department to perform tank cutting? NA[ j YES( ) Nk <br />5. Is there knowledge or evidence of leakage from the s) andlor piping? (1f yes, please explain) YESXNO ] j <br />PRE�imino �. nvcSfioaofi.Cr1 , c' � zr� �c'-&? i CdA_r Zo <br />6. If tank residual exists, Identify transporting /hazardous waste hauler. <br />Name ALP, CAL Q 1 fr Hauler Registration <br />Address el 0- 8C ,X b 7 5 cityZip SJ�J <br />Phoned cR.0 L to / — W L <br />7. Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to remova17 YEs NO ( j <br />b. Identify contractor performing decontamination: <br />Name l� 8 V9n)C r(1 Geo FAviroArvell+c. 'IC . <br />Address 7/JO S /l/. I I�,JSo +N (li�i Y L7[y J%( ir7y,/ Zip 9720 <br />Phone No4 20 C1 <br />C. Describe method to be used for decon tion: l <br />�PSS,•rP, X.X aZ5 j -�'r, tq T)fo7At hFl7!? <br />_ d. Describe how tinsate material will be stored onsite prior to manifesting oftsite: <br />LSC 0'_—.,17_ _ __i ) ke /1 _ _rn .'_.1 4 <br />e. Rlasate Haulerandpermitted Treatment, Storage & Disposal Facility: <br />Hauler NameI\l^Ct2 {��i0 l 11 Hauler Registration lQ �R <br />Address—L), Go, �city �n,R ��� zip 15& <br />Phone No. <br />Permitted <br />EH 23 046 (Revised 10119198) <br />Page 4 <br />-XD -,*- <br />Y52 <br />y5Z 7C$ <br />