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From Ivan Ve9vary & Associates PHONE No. : 510 947 1051 r -1.08 1997 6:17RM P05 <br /> 1. (a) is there a PHS-EI D contractor's questionnaire on nto or enclosed? YES [ I NO <br /> (b) Is the current certificate of worker's compensation insurance on file? YES ( I NO <br /> (c) Does the contractor Possess a "Haordoua 8nhsanen Removal Certification"? YES It NO <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 11 NOK <br /> 2. Has a "Sitc Health &Safety Plan" for this job site been submitted? AO% Aed YES P( NO [ J <br /> 7. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A,' YFA I I NO I I If YES, Permit a <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAXYHSI I NOI I <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES I I NO <br /> 6. It tank residual exists, identify transporting hazardous waste hauler: <br /> A10 /1�Ji C>'LfR r "er'oi s rY <br /> Name Hauler Registration # <br /> Address City Zip <br /> Phone 0 ( ) <br /> 7. Dammaminatlon Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES I I Now <br /> Identify contractor performing decontamination: <br /> Name NSA <br /> Address city Zip <br /> Phone No( ) <br /> Describe method to be used for decontamination: <br /> A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: N <br /> llf <br /> e. Rlasate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> H�uler Name �/� Hauler Registration # <br /> Address City Zip_ <br /> Phone No. ( ) <br /> Permitted Disposal Sitc <br /> EH 23 046 (Revised 7/10/96) Page 4 <br />