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1. (a) Il there a PHS-EIID contractor's gaesllonnaire on file or enclosed? YES M NO ( <br /> (b) b the carrent certificate of worker's compensation Insurance an file? YES NO <br /> (c) Does the contractor possess a "Fla"t-doom Sabstaece Removal Certlfintioa"? YES NO <br /> (d) tons everyone on site, Including crane/backhoe operator, been certified <br /> to work on harnrdous waste site In accordance with CCR Tilde 6? YES a NO <br /> 2. loss a "Site Heam A Safety Plan" for this job ille been submitted? YES NO <br /> 1. ling ap olcant performing removal In the City of Tracy obtained a ^Grading and 6aeavatioa Permfl"? <br /> N/A; YES I I NO ( I If YES, Permit 8 upon approval <br /> 4. lips the contractor obtained approval from the local fire department to perform lank cutting? NA( ( YE51 I NON <br /> 5. It there knowledge or evidence of leakage from the lank(s) and/or piping? (if yes, plus# elplaln) YES i ) NON <br /> A. of lank reiidoal eslsts, Identify transporting hazardous waste harder: <br /> Name Nor Cal Waste Oil Haulers _ Hauler Registration N CAD 982417255 <br /> Address P. 0. Box 645 _ City Denair, CA ZIP 95316 <br /> Phone of 800 332-8710 <br /> 7. Decontamination Ptoemores: <br /> s. Mll tonk(s) and piping be decontaminated prior to removal? YES DQ NO ( <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc. <br /> Address P. 0. Box 357 Cloy Lodi ZIP 96241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> C. Describe method to be need for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> _1111 hn. watr+r <br /> d. Describe how rinsele material will be stored omlle prior to manifesting offsllel <br /> Ninsate will bither be removed from the tank the astg oil hauler while <br /> _t a Sauk and-li es -are being r rased or b�Q�� n�a a aed drumi, <br /> on site unto t e1 h y can he removed to a proper disposa ac ty. <br /> e. Rlnsafe Hander and permitted Treatment, Storage & Disposal Pacllltyi <br /> Tinder Name sante as #6 Harrier Registration N <br /> Address City ZIP <br /> Phone No. ( ) <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs, NV 89429 <br /> -1 <br /> Ell 23 046 (Revised 9/11/96) Page 4 <br />