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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES xj NO[] <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES NO(] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO[] <br /> (d) Has everyone on site,Including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES)f NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES'Yr NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAX YES[] NO]] If YES, Permit d <br /> 4. Has the contractor obtained approval from the local IIre department to perform tank cutting?NA[]YES[]NOp{ <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[] N/, <br /> G. If tank residual exists,Identity transporting hazardous waste hauler. <br /> NameLl,--RA 1 0 I1 Hauler Registration# <br /> P. (� Zy/ a <br /> Address - A'7c� �9. /5 City DFIVA;R trip 1531 � <br /> Phoned 2rj l! 7 "!�� 2- <br /> 7. <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES NO[] <br /> b. Identity contractor performing decontamination: // ` <br /> Name AdVANC<t) C( � Cn� nnNlFnliA I ^nc <br /> Address ypO 6 (U. 111, 156n �V A r city S%-, e ion zip <br /> Phone No{ 'ZO� ] 4 o / 006 <br /> C. Describe method to be used for decontamination: �1 <br /> /%JieSSvrz i ,Asr} int TA"vKS �nl� t7iln,'� ci�A i �y /7 >�c <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rir68 ie wdl bF pymCKo em r of TANKS F n�a ,9 ma b;lE <br /> UAC%:rn TAur rCN 0. tAl col � <br /> e. Rinsate Hauler and permittedTreatment,Storage&Disposal Faciliy: <br /> t <br /> Hauler Name LLA col 0i 1 I Hauler Registration d -Z <br /> Address R 0. 8 QX y City zip 1 ! 6 <br /> Phone No.( aoO 1 67 Lb y2 <br /> _ YY�-nus !pq So# <br /> Permitted Disposal Site c�tls+riA ] SC-A"i('L 0; 1 CO • caQ-,o945Z7c8 <br /> EH 23 046 (Revised 10119198) Page 4 <br />