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1. (a) Is there a PHS-EI-ID contractor's questionnaire on file or enclosed? YES [Jr NO [ <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [ j NO [,/[ lrAT. <br /> (c) Does the contractor possess a "Elaardons Substance Removal Certification"? YES NO [ j <br /> (d) Has everyone on site, including crane/backhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES [ NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES ( ] NO [� <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A W YES [ ] NO [ ] If YES, Permit # <br /> i. Has the contractor obtained approval from the local fire department to perform tank cutting? NA(M/Y/ES( ] NO( ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NOV <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name A`q�.1(A41 i u `dEU J iC�� Hauler Regixt atiou # l mro i i54 <br /> Address o 1 �� / i�► ���b City 6 L e �ZiP _ <br /> Phone m (� �� -732 4L4 J <br /> 7. Decontamination Procedures: / <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES M NO <br /> b. Identify contractor performing decontamination: <br /> Name WE)L `` ,1 EZ}a' (5:..:Si� �'rr—y4R n (� <br /> Address IDOJ-`i ©�p�1�t) ir Arkk , City <br /> Phone No.(2n ) O` -7 911)l <br /> C. Describe method to be used for decontamination: <br /> Fp E t t_t,a:C [.)CpT t tel't= * <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> , bol 11 rl( 4 M fUdvlf)_D G1RE2rL�1 6� IkiEI'.1Zr8Y1 <br /> e. Rinsate Hauler and permitted Treatment, Storag�e,�& Disposal Facility: ,� nJ + r <br /> Hauler Name i�rlr.�121 C-1�'i 1/'tl,Q{..�''� iO� �a IW <br /> Re'gi1stration #tkL pM I L 11✓ <br /> Address 2n � F-at`S 1J I q , I-S City I W` LFZK Zip 153Y)— <br /> Phone No. ( ) 7161 -732_ 4L45 <br /> (�, 7 ��r7 `,r, �,1 C !� v ,1 �,,, <br /> Permitted Disposal Site � i t`b u 1`t Kullx" l.0 F"P. <br /> EH 23 046 (Revised 7/10/96) Page 4 <br />