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1. (a) Is there aPHS-EHD contractor's questionnaire on file Ie or enclosed? NO ( <br /> (b) Is the current certificate of worker's compensation insurance on file? YES („}i NO [ J <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [,K 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 [vl NO ( J <br /> ?. Has a "Site Health & Safety Plan" for this job site been submitted? YES M", NO <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [,-r' YES [ J NO ( J If YES, Permit R <br /> d. Has the contractor obtained approval from the local fire department to perform tank cutting? NA(vJ'YES[ J NO( ( <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ J NO <br /> 6. If tank residual �� idp <br /> exists, identify transporting hazardous waste hauler: p <br /> `lame /•ffW t� L a Hauler Registration <br /> Address 7;b ?or— W5:7 City Zip <br /> Phone <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES ( NO [ J <br /> b. Identify contractor performing decontamination: <br /> Name iQl�fAq✓ICE0 OL-f7 >�Nf/b �1ML/1 <br /> Address 4 ,)JAUZY bU'kL WAt.1 City !r--AZ44-& ►. Zip ! �] <br /> Phone No.( ? - ao (a <br /> C. Describe method to be used for decontamination: <br /> _ s 21,1$E W/7Yl At i � <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: �7 <br /> Hauler Name M' a0d, 4 Hauler Registration 7 g2 172 . <br /> Address `;�D B-06SSI City � �l1L Zip g.53KO <br /> Phone No. ( 2-0-744 <br /> ) 7 — 6,6?1 — <br /> Permitted Disposal Site +nf& 2s7a ACAJ,Oy7bjp . S/�t.52, <br /> AND 419Q&6.3cff <br /> EH :3 046 (Revised 7/10/96) Page 4 B9�z� <br />