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] . (a) Is there a F,1-113 contractor's and suhcontractor's questionnaire on the or cncloscd? YES ✓] 'NC [] <br />(b) Is the current certificate of worker's compensation insurance on file'? YES a NO 0 <br />(c) Docs the contractor possess a "Hazardous Substance Removal Certification"? YES [] NO EJ <br />(d) Has everyone on site, including crane/backhoe operator, been cortitied to work on <br />hazardous waste site in accordance with CCR Title 8? YES EJ No F] <br />2. Has a "Site Health & Safety Phtn" for this job site been submitted? YES ©✓ NO <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation 11'ernrit"? <br />NIA EJ YES ❑ NO Q If YES, Permit # u <br />4. Has the contractor obtained approval from the local Dore deparhnent to perform tank cutting? NAE] YI-S[I NO❑ <br />S. Is these knowledge or evidence of lc&age front the tank(s) and/or piping? (If yes, please explain) YES L) NO E <br />6. If tank residual exists, identify transporting; hazardous waste hauler: <br />Nan1e Asbury Environmental Hauler Registration #_-_ 0015 <br />Address 7300 Chevron 'Way cit, Dixon zip 05620 — <br />Phone # f $00 <br />7. Decontamination Procedures - <br />727 -2879 <br />a. Will tanlc(s) and piping be decontaminated prior to removal? YES LTJ NO <br />b. Identify contractor performing decontamination. <br />Name — D & S Dragline Service <br />Address 540 )~ Street city Los Banos Lip 93635 <br />Phone No_( 209 J 826-4252. T <br />C. Describe method to be used for decontamination: <br />D & S will use a pressure washer to rinse the tanks, then add liguinox to the tank and <br />rinse it a second time followed by a thlyd rinsing with water, between each rinsing the Rinsate will be <br />drained or pumped into a drum for disposal. <br />d. Describe how rinsato material will be stored onsite prior to manifesting offlite: <br />11insate will be stored in drums and disposed of by Asbury EnvirorunentaJ <br />_The drums will be labeled as non -hazardous waste and will be remove frDm the site within 30 days <br />C. Rimate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Mauler Name Asbury Environmental Hauler Rogistration # 0015 <br />Address 7300 Chevron Way City Dixon Zip 95620,___ <br />Phone. No. ! 800 <br />727-2879 <br />Permitted Disposal Site_ Asbury DK <br />8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br />a minimum of 15 lbs of solid carbon dioxide (Dry ice) will be addod to each tank 1.5 <br />hours prior to tank removal. <br />EH 23 046 (Revised 813/07) 4 <br />