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v <br /> NOIJ <br /> 1, (a) Is there a PHS-EHD contractor's and subcontractor s questionnaire on the or enclosed? E$�~(] NO[] <br /> (b) Is the current certificate of worker's compeusatlon Insurance on file? YE NO() <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YEW NO[) <br /> 2. Has a"Site Health&Safety Plan" for this)ab site been submitted? <br /> YES)} NO. <br /> 3. Has applicant performing removal YES, <br /> e City ofTracyracy obtained a"Grading and Excavation Permit"? <br /> NIA[] YES[] NO[] <br /> 4. H e contractor obtained approval from the local fire department to perform tank cutting?NA�jYEt NO[] <br /> ] <br /> Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[] N0�}, <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. c �1 <br /> Hauler Registration#y3_1 f <br /> Name /1 �1 �- �—-, <br /> a+ C t], � 1. 99 b7 F✓I City zip �J3 X1 .5 <br /> Address <br /> Phone#( 40n) C� aa' ^ oGZw <br /> 7. Decontamination Procedures: <br /> S ] <br /> a. Will tankYENO[ <br /> s)and piping he decontaminated prior[o removalT l <br /> b. Identify contractor performing decontamination: ' <br /> Name L �r- c ry <br /> Address <br /> s u >rLS� ? city S40 to Zip �t 5X15 <br /> Phone No.(r�-D5 1 q <br /> A <br /> c. Describe method to be used for decontamination: <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 <I I n Hauler Registration# <br /> Address <br /> �n c-!l 5 R I k G{ A Z\v2X City Zip � �0 <br /> Phone No.('iL!j ) f'�`A S I T)d <br /> Permitted Disposal Site <br /> EA 23 046 (Revised 08113199) Page 4 <br />