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I. (s) b there a PHS-FlID contractor's questionnaire on Me or enclosed? YES kj NO I I <br /> i <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES NO I I <br /> (c) Does the contractor possess a "Inazardova Substance Removal Certification"? YES NO I I <br /> (d) 11a9 everyone on vile, Including crane/backhoe operator, been certified <br /> to work on hazardous waste site In accordance with CCR Title 97 YES NO I i <br /> 2. Ilan a "Site Health A Sorely Plan" for this Job site been submitted? YES W NO I I <br /> 3. Iles applicant performing removal In the City of Tracy obtaineda "Credleg and Excavation Permit"? <br /> N/AiK YES I I NO I I If YES, Permit N upon approval <br /> 4. Hot the contractor obtained approval from the local fire department to perform lank cutting? NAI I YESI I NON <br /> S. Is there knowledge or evidence of leakage from Ilse lank(s) and/or piping? (If yes, please explain) YES I I NON <br /> 6. If lank residual exists, Identify transporting hazardous waste hauler: <br /> Name Nor Cal Waste Oil Haulers Ilaeler Registration N CAD 982417255 <br /> Address P. 0. Box 645 City Dena ir, CA ZIP95316 <br /> Phone a ( 800 332-8710 _ <br /> 2. Decenlaminsllor Procedures: <br /> a. Wool tank(s) and piping be deconlstnlnated prior to removal? YES Yc NO I I <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc. <br /> Address P. 0. Box 357 City Lodi ZIP 98241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> C. Descrlbe method Io he used for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> d, Dncrlbe how renssle maleriel will be soured ondle prior to manifesting pffslle: <br /> Rinsate will bither be removed from the tank by the waste oil hauler While <br /> the tank and lines are be Lored in labled and sealed <br /> on s to onto they can be removed to a proper disposal facility. <br /> e. RlnsMe Hauler end permitted Treatment, Storage & Disposal Facllllyu <br /> Hauler Name same as p6 liarler Registration N <br /> Address Cloy Zlp <br /> Phone No. ) <br /> Permitted DlspnsslSite Americlean, Inc. 2570 Almond Dr. , Silver Springs, NV 89429 <br /> 3/20 <br /> Fit 23 046 (Revised 9/11/96) Page 4 <br />