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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YESK] NO[] <br /> (b) Is the current certificate of worker's compensation Insurance an file? YES P9 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 8? YES¢J NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES(J NO ff <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N1AjM YES[] NO I] If YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAJQ YES[]NO[] <br /> S. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[J NO 6I <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name E.!.t. Hauler Registration M 53'� <br /> Address 25S P2rr 13Lvt,+. City Richmond Zip 998D1 <br /> Phone lD 235-13 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES4 NO(I <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address 2S5 Parr blvd, City [;466rnonoi Zip g4-6o) <br /> PhoneNo.( 510 ] 235- 13413 <br /> C. Describe method to be used for decontamination: <br /> Ply ...;u Iz drained into the +ankf, will be i'ride.•rinscd . R1'ns71'e wilt <br /> bt remwed 4,v V9GUUrn truck . <br /> d. Describe how riusate material will be stored onsite prior to manifesting offsite: <br /> LiAl ncF be Store on she- -H w;ll 4�a f mmedi.Acly pompsd Ini-o the <br /> yau.Um trVekar,d r _mewed <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal FadHty: <br /> Hauler Name E.G.I. Hauler Registration# I'D 32) <br /> Address Z5S P2rr r3lvr(• City Kfchnnond Zip 61`1801 <br /> Phone No.( 510 1 235- <br /> Permitted Disposal Site E.G.I . -ki chmond <br /> EH 23 046 (Revised 10119198) Page 4 <br />