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1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES P. /NO[] (b) Is the current certificate of worker's compensation insurance on file? YES k- NO(] (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES(] NO(J (d) Has everyone on site,including cranelbackhoe operator,been certified to work on hazardous waste site in accordance with CCR Title 8? YES NO]] 2. Has a "Site Health&Safety Plan" for this job site been submltted7 YES NO I] 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? NIA[] YES]] NO]] If YES, Permit# AIA ' ,¢000IC14/61E 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[J YES[]NO(ql� 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES[J NO[.j/ 6. If tank residual exists,Identify transporting hazardous waste hauler. Name O.c, Hauler Registration# 3 7 Y Y Address Pe. QO X 3'1 a city ELN I Zip 9.53/,$' Phone#LZoc —^!P -7 3 Z - 41,6 7. Decontamination Procedures: a. Will tank(s)and piping be decontaminated prior to removal? YES[or'NO[] b. Identify contractor performing decontamination: Name 8,9 z✓E,t/ I W Address 333D Ko�i� �d�f cls zip 9SZo io Phone No C. Describe method to be used for decontamination: 1:�,Lv�ZwlcL vZiraP�D oF,4eL RZet/JGCT— T�4N�s Tfrfit/ /✓ict Bt d. Describe how rinsate material will be stored onsite prior to manifesting offsite: 2/A/SF.4TE /S KELT/•t/Tf1E 71164r—S e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: Hauler Name Ayi//0J//C4A/ ✓4LGE Hauler Registration# 37�f Address 12_O . /fig X 3�40 city P,6-1-14 Zip Phone No.( ) I'*�'V — ZF;Z— Y6 4S Permitted Disposal Site /1VOdbTiQ11qL OIL 5E4v/CF cal—yAee +,✓Y EH 23 046 (Revised 10119198) Page 4