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I. (a) Is there a PHS-EIID contractor's questionnaire on file or enclosed? YES NO <br /> (b) Is the current cerilRcate of worker's compensation Insurance on Ole? YES NO <br /> (c) Does the contractor possess a Hazardous Substance Removal Certification"? YES NO <br /> (d) fins everyone on site, Including crone/backhoe operator, been certified <br /> to work on hazardous waste site In accordance with CCR Title g? YES QQ NO <br /> 2. Has a "Site Health & Safety Plan' for this Job site been submitted? YES NO <br /> 3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A M YES I I NO I I If YES, Permit N upon approval <br /> 4. Has the contractor obtained approval from the local fire department to perform lank cutting? NAI I YES( I NON <br /> 5. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (if yes, please explain) YES I I NO N <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler: <br /> Name Nor Cal Waste Oil Haulers Hauler Re&(ratlou N CAD 982417255 <br /> Address P. 0. Box 645 City Denair, CA Zip 95316 <br /> Phone N ( 800 ) 332-8710 <br /> 7. Decontamination Procedures: <br /> e. Will tank(s) and piping be decontaminated prior to removal? YES t4 NO <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. Describe method to be used for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> and hot water. <br /> d. Describe how rinsate material will be stored onsile prior to manifesting gffslte: <br /> Rinsate will ✓3ither be removed from the tank by the waste oil hauler while <br /> the tank and lines are being rinsed or stored in labled_and sealed drums <br /> on site unt 1 they can be removed to a proper disposal facility. <br /> e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Same as #6 Hauler Registration N <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs , N4 89429 <br /> 5/20 <br /> EH 23 046 (Revised 9/11/96) Page 4 <br />