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1. <br />2. <br />3, <br />4. <br />5. <br />A <br />7 <br />8. <br />(a) Is there a EHD contractor's an iubcontractor's questionnaire on file or enclose YES Q <br />NO ❑ <br />(b) Is the current certificate of worker's compensation insurance on file? <br />YES [] NO ❑ <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES E] <br />NO ❑ <br />(d) Has everyone on site, including crane/backhoe operator, been certified to work on <br />hazardous waste site in accordance with CCR Title 8? <br />YES NO 0 <br />Has a "Site Health & Safety Plan" for this job site been submitted? YES ❑ <br />NO <br />Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br />b. Identify contractor performing decontamination: <br />NIA 0 YES ❑ NO ❑ If YES, Permit # <br />Name D & S Dragline Service <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[] YES[] <br />NO[:] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain) YES ❑ NO0 <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name Asbury Environmental Hauler Registration # 0015 <br />Address 7300 Chevron Way City Dixon <br />Zip 95620 <br />Phone # ( 800J 727-2879 <br />Decontamination Procedures. <br />a. Will tank(s) and piping be decontaminated prior to removal? <br />YES 0 NO ❑ <br />b. Identify contractor performing decontamination: <br />Name D & S Dragline Service <br />Address 540 F Street City Los Banos <br />zip 93635 <br />Phone No.( 209 826-4252 <br />C. Describe method to be used for decontamination: <br />Triple Rinse both tanks <br />d. Describe bow rinsate material will be stored onsite prior to manifesting offsite: <br />Rinsate will be stored in drums and disposed of by Asbury <br />Environmental <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Asbury Environmental Hauler Registration # 0015 <br />Address 7300 Chevron Way City Dixon <br />Zip 95620 <br />Phone No. ( 800 727-2879 <br />Permitted Disposal Site Asbury DK <br />a. Describe the method that will be utilized to purge and/or inert the tank(s): <br />a minimum of 10 lbs of solid carbon dioxide (Dry ice) will be added to each tank 1.5 <br />hours prior to tank removal. <br />EH 23 046 (Revised 8/3/07) 4 <br />