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1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES p)! NO[] <br /> (b) Is the current certificate of worker's compensation insurance on Elle? YES(�yC��NO[] <br /> (c) Does the connector possess a"Hazardous Substance Removal Certification"? YESjNO[] <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)f NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES`r kNO]] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA-K YES[j NO[] If YES, Permit R <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NOf{� <br /> S. Is there knowledge or evidence of leakage from thetgn�js)andJor piping? (If yes,please explain)YES NO[] <br /> PL <br /> RQ;1niA0.,4 utV ' ;!Ambo! r `f, rrr ,A7'U) 8IFDc,P.i (dATFA 7 r.t:" /496) <br /> cojFirrneo ejr ltvn-� con•1-omiy,+,t4 in haTH a,) c rnrc ,Id W,9Tf& <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name ALA CAL Q//� (� :5Hauler Registration X P12— <br /> Address e, (2. F2/ 2c City J)f R <br /> tyA _ Zip 0) <br /> Phone d�J b 67 - <br /> 7— L 69 Z <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YEKNO[j <br /> b. Identify contractor performingdecontamination: <br /> Name A av9rJ( ih (;eQ FAviror)03 rn_is . <br /> Address yro S N. I.U.►5,, k)A Y city 5Tar,g-Ta,✓ zip 95zcj <br /> Phone No420 f1 ) Ab — cc, ( <br /> C. Describe method to be used for decors tion: <br /> �ReSS•)r ''1 <br /> d. D sibe crhow rinsate material will be stored onsite prior to manifesting offsite: <br /> S QinS� ie S if� JI bf Dun,acD <br /> m cb ►e I �A cu y vc K ,q sAlQ I <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name z Hauler Registration N (►� <br /> Address n. G l CityQAAA_ZIP <br /> Phone No. �1 <br /> Permitted Disposal Site _[n c % -+f I'd a Q Xi(g I ca uCAD n4 9 y 5Z 7D F5 <br /> EH 23 046 (Revised 10119198) Page 4 <br />