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1. (a) Is there a PHSTHD contractor's and subcontractor's questionnaire on file or enclosed? YES$] NO[] <br /> (b) Is the current certificate of worker's compensation insurance on Me? YES$] NO[] <br /> (c) Does the contractor possess a"Hazardous 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? YESK] NO[1 <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YESY.] NO[] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[T YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[[NO[]Pending <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? Of yes,please explain)YES[J NO 14 <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name American Valley waste Oil Hauler Registration# CAL000827878 <br /> Address P.O. Box 340 City Delh; ZIP-9511-5— <br /> Phone#( <br /> IP 95'i1 SPhone#( 800 ) 732-4645 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[T, NOI] <br /> b. Identify contractor performing decontamination: <br /> Name Oil Equipment Service �w <br /> San <br /> Address P.O. Box 950 CityAndreas Zip 95249 <br /> Phone No.( 209 ) 754-1808 <br /> C. Describe method to be used for decontamination: <br /> Triple rinse and p imp Via VACUUM trUCIr <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> N/A-Directly to vacuum truck and transported to approved <br /> disposal s; <br /> e Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name American Valley Waste Oil Hauler Registration# CAL 0'100827878 <br /> Address P.O. Box 340 City Delhi _ _ 7iP 95315 <br /> Phone No.(_800 __) 732-4645 <br /> Permitted Disposal Site Riverbank Oil Transfer <br /> .IC�'6 r''-1'b1.f.Pl '�VrAM,S�prt' <br /> EA 23 046 (ReviGed 08113199) Page 9 p fti�'M''A 0rti`(.t <br /> 1 <br /> wrge.or (-c4ai4 Wi tt1tt5 . <br />