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JUL.-01' 00 (FRI) 10: 13 RB CONST 'TION IN TEL:510 68382 P. 002 <br /> w <br /> 1. (a) Is there a PHS•EHD contractor's and subcontractors questionnaire on file or enclosed? YES NO[] <br /> (b) Is the current certificate of worker's compensation Insurance on file? 140[1 <br /> ] N0[1 <br /> (c) Does the contractor Possess a"HaZardous Substance Removal Certification"? <br /> (d) Has everyone on site.Including cranelbaekhee operator,been certified NO[] <br /> to work on hazardous waste site in accordance with CCR Title 87 TE <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES JV NO, <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[[ YES[1 NO[I It YES, Permit d <br /> 4- H e contractor obtained approval from the local fire department to perform tank cutting?NA$YYE: NO[] <br /> Is there knowledge or evidence of leakage from the tank(s)andlor piping? (It yes,please Mlatu)YES(J 140� <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. �f <br /> Name Z Atni7 CS ���n"��CI�i Hauler Registration#Z� <br /> � _ - <br /> PI <br /> Address 4 fd7 .[ � gj city1�4,c -- 71pJ��—J— <br /> PhoneN( `3 ) g3o� OCod <br /> 7. Decontamination Procedures: <br /> a- wID tank(s)and piping be decontaminated prior to removal? YE� NO[I <br /> b- Identify contractor performing decontaminadow <br /> Name 2 <br /> Address �4! D S- w� qui �}city or �Yvh ZIP <br /> PhoneNo.(� )._ ��a 0 (.D <br /> e. De be method to be used for decontamination: <br /> d. Describe how rhrsate material will he stored onsite prior to manifesting offsite: <br /> �Lre. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name o --� < t p Hauler Registration#,000y T7 l SU <br /> Address"5n S O u s R k 1 d A a\ j City Li 6; k 5 7dp 953& <br /> Phone No.a4 �5- [ 4!!L- &7fj8*" — <br /> Permitted Dispos �0 I LI q ' AFt 1t 1$LA) lO Zi &6 Rjep <br /> 5-e—EH 23 046 (Revised 08113199) Page 4 7'J f 33 <br />