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1. (a) is there a PHS-EBD contractor's andsuhcautractor's questionnaire on file or enclosed? YES� 'o[] <br /> ' (b) Is the current certificate of worker's compensation insurance on file? YES Id [1 <br /> (c) Does the contractor possess a"Hazardons Substance Removal Certification"? YES 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(4,40(] <br /> ?- Has a"Site Health&Safety Plan" for this]ab site been submitted? YES NO t <br /> 3. Has ap cant performing removal in the City of Tracy obtained a"Grading and fficavation Permit"? <br /> NIA W YES[] No(] If YES, Permit# <br /> 14- Has the contractor obtained approval from the local fire department to perform tank cutting?NAj e s(],No[] <br /> 5. Is there knowledge or evidence of leakage from the tanks)andfor piping? (If yes,please explain)YES[j NO <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name F' r ] Hauler Registratian# j rj 33 <br /> Address ZSS PA-wZ &0 U Ll✓Y A,0 City 12Id.4/K1F14 Q Zip --Sol <br /> Phoned( 510 ) -Z '2,5 - 1 -1 <br /> 7. DecontaminationProcadocres: <br /> Ia. Will tank(s)and piping be decontaminated prior to removal? YESX NO(] <br /> ' b. Identify contractor performing decantaminatiom <br /> Name EG <br /> Address Z55 PAfZg- E50ULaVA-P-0 citypucHM4niD zip 94801 <br /> Phone No4 I I 0 ) 235 - t 34 3 <br /> C. Describe method to be used for decontamination: <br /> YAC uUM TRveK. REmovAtoFRES Ou�L Fuel NOT <br /> tc! " r-K ,4r1D B+oOEGRAOA6I,E �fF� (Ltl-1SE�R1rJ51R�n v�a'Y fJSrI,LEs <br /> Y�uum -rRvc�c <br /> d. Describe haw rinsate material will be stared onsite prior to manifeeating offsite: �J ; <br /> STogF� tbJ VAC-U vel TAVCK ,TP.A-+!s P ru�FD u 1 YAa <br /> ' e. Rinsate Hauler and permitted Treatment,Storage &Disposal Facility: <br /> Hauler Name D t 5 po SAL-FOM tC N.PZM&e_A L toR crier Registration 4 l Co O <br /> Address �? O 81 a4y Rd City J5 si PA L-O AL:M Zip <br /> 1 Phone Na.( 6L;70 ) -71 2,+— 3 <br /> Permitted Disposal Site �Bx OT u � 1 30 �(� T l �N�7 �t ' <br />