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88112!2002 13:19 2934583433 FIFTH FLOOR PAGE 05 <br /> I. (s) Is there a EHD contractor's and subconS%actor'aquestionnaire on file or enclosed? YES 91; (} <br /> (h) is the current certificate of worker's compensation insurance on file? YES [� 0(] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES [ NO(1. <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on YES tj-- RT <br /> O <br /> (e) hazardous waste site in accordance with CCR Title 8? , / [' <br /> 2_ Has a"Site Health&Safety Plan"for this job site been submitted? YES CI NO{1 <br /> S. li9alawligant performing removal in the City of Tracy obtained a"Grading ana Excavation Permit"? <br /> NIAM YE•S{} NO t} If YES, Permit# <br /> 4, hiss the zout ac¢..or obtained approval from the local fire department to perform tank cutting? NA(] YES <br /> NO(] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain) YES (] <br /> NO 11 <br /> & If tank residual wdtte,i ratify transporting hazardous waste hauler: <br /> lame /N Hattler Registration# <br /> Address City Zip <br /> Phone#(_ ) <br /> 7, Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES 1'1 LV 0 (] <br /> b. Identify con ctor performingdecontamination, <br /> \ <br /> Name 7�IAV� r— ) <br /> Address City zip <br /> Phone No.( --) <br /> c, Describe metbod to be geed for decontamination: <br /> d. Desczsyhe how rinsate ma rral will be stored onsite p for to,Znanifes ng offsiteF <br /> /�4p 5��� Spy'•-b� (3,�--r�.t� (��ti l <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Hauler Registration# <br /> Address City zip <br /> Phone No_(_ ) <br /> Permitted Disposal Site <br /> SH 23 046 (jievised 3115102) Page 4 <br />