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� v <br /> 1• (a) v there a PHS-EFID contractor's questionnaire on rile or enclosed? YESNO ( J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES Q NO [ J <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [t. NO [ <br /> (d) Has everyone on site, including crnnelbackhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES P(l NO [ ] <br /> _. Has a "Site Health & Safety Plan" for this job site been submitted? YES' f NO ( J <br /> �. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permif•? <br /> N/A YES [ J NO [ J If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAf ] YES( ] NOK <br /> _• Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ J NO �f <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. 7` <br /> Name }-:y�o c-.^ �•a cn f\ Hauler Regist atiou <br /> l <br /> Address ,�4 Zig[tin r v\ `\ry J City,-'���,Ur!.��l r^G�iP cI ck� <br /> PhoneCc) <br /> Decontamination <br /> • Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES NO [ ] <br /> b. Identify contractor performing decontamination: ` <br /> ):�c.�w.c ... \ <br /> Address _ is '7 E I t v� � � City Zip SiX317 L <br /> Phone No.( ac'4 <br /> c- Describe method to be used for decontamination: <br /> �.J <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> P" I <br /> Ccc– <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name j—itiiL` n Z� <br /> t Hauler Registration <br /> Address o!1" ,L �--� t�i�lr••nC� LC\�� City St.iVQC iPa q a <br /> Phone No. ( ' CC-a 1 j _ G l ( , <br /> Permitted Disposal Site j1 ren.: �,' r^.1 :... „� .� i �. Y; \ r <br /> :3 (�4 � <br /> EH 046 (Revised 9/11/9 Page 4 / <br />