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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES , NO]] <br /> (b) Is the current certificate of worker's compensation insurance on file? YE NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YESA NO[I <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YESJQ NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA�U YES[] NO[I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?N*YES[I NO[J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[] NDDA <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Namell�_, \C^hk Hauler Registration# 1533 <br /> Address25-J zk Rwb City Zip 9�w/ <br /> Phone#( 5\() ) 2s 1393 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YE$K NO[I <br /> b. Identify contractor performing decontamination: <br /> Name /� 4E U <br /> Address 2� C Cy&?kI�_ City maw zip qqw/ <br /> Phone No.( 5K) ) 22& L3 Q l2) <br /> C. Describe method to be used ordecoptamina o <br /> yt <br /> d. Describe how rin'a[e�,mantc�l;1 <br /> be stake site to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Mjuler Registration# 1 533 <br /> Address City 0)D zip l(J"r <br /> Phone No.(,�3— 0 ) Q 3 <br /> Permitted Disposal Stte !/1 <br /> EH 23 046 (Revised 08113199) Page 4 <br />