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1. (a) Is there a EHD contractor sf and subcontractor's questionnaire on file or enclosed? YES K NO[] <br />(b) Is the current certificate of worker's compensation insurance on file? YES W NO[] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES A NO[] <br />(d) Has everyone on site, including crane/backhoe operator, been certified to work on <br />(e) hazardous waste site in accordance with CCR Title 8? YES pe] NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES Q(]_ NO( ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/AJS YES [] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] <br />NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES <br />NO [I <br />I�414; Frem /r,pin9 <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name P-amcs Fnylrcy7mell-W Ser✓crts Hauler Registration# 5/`3' <br />city_QA&t Sar+a.+erdo zip 15 <br />Phone # <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES K NO[] <br />b. Identify contractor performing decontamination: <br />Name hnL,&ro,7 wia rf4L `nginer.r[„5 +- CoA FrzzdM 7ae-1 <br />Address 5-0( ParrCevilfr 09r,dL City Canfa. A -m - zip Ot.2-� <br />Phone No.( 7-M ) (26 77--a300 <br />C. Describe method to be used for decontamination: <br />-ft yle— rins-e— <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Fla MOS 5e�uir-e5 Hauler Registration # .51 fr- <br />City ole, SvCrvH.r�o Zip 996S <br />Phone No. <br />Permitted Disposal Site QnmrK EA11,renA'1 qkf -9ar&1fCS <br />EH 23 046 $Revised 3/15/02) Page 4 <br />