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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [X] NO [ ] (b) Is the current certificate of worker's compensation insurance on file? YES [R] NO [ ] (c) Does the contractor possess a "Hazardous Substance Removal Certification?" YES [X] NO [ ] 2. Has a "Site Health&Safety Plan" for this job site been submitted? YES [IL] NO [ ] 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A [X] YES [ ] NO [ ] If YES, Permit# 4. Has contractor obtained approval from the local fire department to perform tank cutting? NA[X] YES [ ] NO [ ] 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes, please explain) YES [ ] NO a 6. If tank residual exists, identify transporting hazardous waste hauler Name: Nor-Cal Waste Oil haulers Hauler Registration#: CAD 982417255 Address: P.O. Box 645 City: Denair, CA Zip: 95316 Phone: (209)332-8710 7. Decontamination Procedures: a. Will tankQs)and piping be decontaminated prior to removal? YES PC] NO [ ] b. Identify contractor performing decontamination: Name: Jim Thorpe Oil Co., Inc. Address: 351 N.Bedunan Road/P.O. Box 357 City: Lmli, CA Zip: 95241-0357 Phone No. (209)4624581 or(209)368-6175 C. Describe method to be used for decontamination: Tanks and piping will be triple rinsed with hot water and biodegradable soap solution. d. Describe how rinsate material will be stored on-site prior to manifesting off-site: The rinsate will be removed by Jim Thorpe Oil, Inc., personnel and be placed in drums. The dnuns will be fabled and stored on site awaiting pick up for disposal at a proper disposal facility. e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: Hauler Name: Same as No. 6 Hauler Registration#: Address: City: Zip: Phone No. Permitted Disposal Site: Refineries Services,Patterson, CA, or other approved facility. Page 4