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I, (a) If there a PIIS-EIID contractor's questionnaire on Ole or enclosed? YES Ih NO I I (b) is the current certificate of worker's compensation Insurance on Ole? YES NO I I (c) Does the contractor possess a "Hanrdous Substance Removal Certiflesdon"? YES NO I I (d) Hag everyone on site, Including crone/backhoe operator, been certified to work on harardous waste site In accordance with CCR Title 8? YES NO I I 2. lifts a "Site Health 4 Surely rise" for this job site been submitted? YES a NO I I 1. ling ftp Ilcanl performing removal in the City of Tracy obtained a "Grading and Excavation Persil"? N/A YES I I NO I I If YES, Permit N upon approval 4. ling the contractor obtained approval from the local fire department to perform lank cutting? NAI I YESI I NON 5. Is there knowledge or evidence of leakage from lite lank(s) and/or piping? (if yes, plea/e explain) YES I I NON 6. If lank relldual exbls, Identify transporting ha7ardous waste hauler: Name Nor Cal Waste Oil Hanlers Hasler Registration N CAD 982417255 Address P. 0. Box 645 city Denair, CA ZIP 95316 Phone K ( 800 ) 332-8710 7. Decontamination Procedures: A. Will tank(s) and piping be decontaminated prior to removal? YES DQ NO I I b. Identify contractor performing decontamination: Name Jim Thorpe Oil , Inc. Address P. 0. Box 357 City Lodi Zip 96241-0357 Phone No. P09 368-6175 e. Descrlbe method Io he used for decontamination: rank(s) and piping will be triple rinsed with a biodegradable soap solution �nri1tr21`xta_te r. d, Deserlbe how rinsate material will he stored onsite prior In manifesting offslle: Rinsate will bither be removed from the tank by the wase oil hjuler while the tank and lines are bean r nsed or in lab ed and a eddrums cot s to not they can a remove to a proper sposa ac ty. e. Rinsate hauler and permitted Treatment, Storage & Disposal Facilltyl Hauler Name same as k6 Hasler Registration N Address City Zip Phone No. ) Permitted Disposal Site Ilmericlean, Inc, 2570 Almond Dr , Silver Springs , NV 89429 5120Pit 13 046 (Revised 9/11/96) Page 4