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r a <br /> r1. (a) Is there a PHS-EHD contractor's questionnaire an file or enclosed? YFS O� NO [ I <br /> (b) Is the current certificate or worker's compeu=don insurance o file? YES [ NO [ I <br /> (c) Does the contractor possess a 'Hazardous Sabstance Removal Certificarioa" YES NO [ ] <br /> 2. Has a *Site Health & Safety Pias'for this job site been submitted? YES NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Gradkig and Exc2vation Permit`.' <br /> N/A [ I YES [ I NO ( ] if YES, Permit # I F/f3 <br /> 4. Has the contractor obtained approval from the load fire department to perform tank cutting? NAArm[ ] NO[ ] <br /> 3. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YYES [ ] NO pQ <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name �rGL(�17 /ET20L�UiYJ Hauler Registratioa # SS <br /> Address �0- ��( /93 City /1104ESjD Zip 93-357- <br /> Phone 1, ( 7-09 ) 3-76 9S00 <br /> i. Decoutamivation Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal YES NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name 54: J1 Co <br /> Address �2/� ;5�k--e7e �f� �l2EET City �OOESTO Zip <br /> Phone No.( 519 ) Sze 96 <br /> C. Describe,�method to be used for decontamination: <br /> THE &IIZ6 156 TZiPLE 4v$Gh fIT /AD'L/3-/fie5 s) how <br /> (/OGlI r ibA SueC Pi1SA;,e, 7;/e7 <br /> FaR�T__�/KE l�/L1_ =t4Z-4oE 77/1=—' <br /> 4 /o0G6LtDEASLF OE�P6Eif THE rUc vqL P/.&SES lu�cG dE CLE1N LvrttE2 <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite. <br /> 71/G .QiroSA7E ,sJg7ESE.�4G !uilL BE $lDR.2� O.�Sl7E /�+ �?/�C S$- 6R[..c,ofj <br /> ORwjiS 4//7h` 9�/,tofiQ/firE' GaheGS <br /> e. Rinsate Hauler and permitted Treatment,Storage & Disposal Facility: <br /> Hauler Name 1441-1,W P'ETRUe'eaw Hauler Regismradoo it /s8 <br /> Address PO. Sod /93 City ,eae6-Y7',O, Zip 9S3sz <br /> Phone No. ( ZOJ ) 5p36 fIS00 <br /> Permitted Disposal Site /TEF/�'ER�j f6CY/GES ��f?T6PS0/y Gam.¢ <br /> Page 4 <br />