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APR 2 2 2008 �L <br /> 1. (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES P NO I] <br /> (b) Is the current conificate of worker's compensation insurance on file?SAN JOAQUIN COUNTY YES[j(' NO(] <br /> (c) Does the contractor possess at"Hazardous Substance Removal Cer'tiftwilwWENTAL YES YV NQ[] <br /> (d) Has everyone on site,including crane/backltoe operator,been CertifidF&i TMAW&RTMENT <br /> hazardous waste site in accordance with CCR Title 8? YES K <br /> NO[] <br /> 2. Has a"Site Health R Safety Plan"for this job site been submitted? YESPr' NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit,"? <br /> N/A0- YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAVYES(] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping'? (If yes,please explain)YES(] NOX <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Aai (_q,) 1410�&J S /7 O/Z Hauler R[elgistradon# 9 <br /> Address 8,g x 'V o Cit} ]� f L/7 Zip <br /> Phone N(.�Q0 ) - J,32 ff 7 /() <br /> 7. Decontamination Procedures: <br /> it. Will tank(s)and piping be ddcontaminaled prior to removal? YESg NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Z int 80X 3 -5;7 <br /> P£ 0a i.ac. <br /> Address —& QOXy3 -5;7 City Z-0-0/ Zip.. s5,.2..9.1/ <br /> Phone No.(_,c�a3_ vlp tr., / 7S <br /> C. Describe method to be used for decontamination: <br /> Z Ho r s �✓ 7;V .4 ZiaD_ /,?4os,QIS/� SD.I� SaLc/Ti�.✓ <br /> gTs,r IIA C y��� ar p.,�s r�o.f S��roswsy <br /> d. Describe how rinsalc�risl will be stored onsitd prior to nun'fesung offsitc: <br /> r <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility; <br /> Hauler Name ( /� �L Hauler Registration k <br /> Address PO OX2 3 40 _City D E L1.1 <br /> Phone No,LACK—00 <br /> Permitted Disposal SiteZ&A i doilk 0/L T.sa�srr,? �'3OO C C f rlS /jogp <br /> r?��/t <br /> Cy/-MO /J0rs�/6 (z09863 Fr>8y) clS3G� <br /> 8. a, Describe the method that will be utilized to purge and/or inert thetan (s): <br /> .DRy_lL�itL/LYL3- A01740T ry� ,ak R r ,arms ofi <br /> _'30 L !SS Jr! lDOO �i4LLQn?3 _ <br /> b, Tank/Piping Hauler: <br /> Name ;T 111P? 16eo/?er Q14 M16 <br /> EH 23 046 (Revised 12(31/07) 4 T <br /> Z0/T0 35tld ONI 3I0 3da0Hl WIC T98T-89E-80Z-T Lb :OT 8002/ZZ/b0 <br />