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I (a) is there a PH&EHD cantraetors and 3ubconn:actora questinnnsira on Ale or enclased". YES Pq NO[) <br /> [b) Is the current certificate of worker's compensation insurance an tile? YES N N0[j <br /> (c) Does the contractor possess a"Hararelons Substance Removal Urdfleatian"? YES 4 No[j <br /> (d) Has everyone an site,including CrMe!baekhoe operate.-,been certlfied <br /> In work on hazardous waste site in accordance wits CCH Tale 9? YES No j 1 <br /> 2. Has a'Site Health S sarety Plan"for this job site been submitted? YES YD[) <br /> 2. Has applicant performing removal to the City of Tracy obtained a"0rading and Excavagon Permit"? <br /> NI&V YES[J NO 1 4 it YES, Permit t <br /> 4 Has the contractor obtained approval from the local Are department to pertarm tank cattle 9*1 5[[No[I <br /> u. Is there knowledge or evidence of leakage!from the tan S)ar.d'or piping? (ft yes,please explain))YES[i YQL_ <br /> 6, if tank residual DOM,Identity traosportlag h2audona waste battler. <br /> Name NORCAL Waste Oil Haulers Hauler RegNtratioa0 CAD 982417255 <br /> Address P.O. Box 645 Ctty Denair, CA no 95316 <br /> phone t( 800? 322-8710 <br /> 7. Decontamination Preeedures: <br /> a. Well tanks)and piping be decontaminated prior to removal? YES[k N01) <br /> b. Idendfy contractor performing deeantaminatloo: <br /> Name Jim Thorpe Oil, Inc. <br /> Address P.O. Box 357 gid Lodi, CA ED 95241-0357 <br /> Phone No; 209 1368-6175 <br /> c. Describe method to be Owed for deeontaminatlen: <br /> T.qnk( -,) will ha t i nl a milsed With n hjnrl�g'r'n r ahl e snap <br /> l } ' t- } + r T + ll ho AQae_ tipe swn@ manner. <br /> d Describe how rinsate material will be stored offsite prior to manifesting offsik: <br /> Rinseate will either be removed from the tank(s) and lines as <br /> they are bein2 rinsed by the waste hauler div � lv into his <br /> truck, or be stored in sealed drums until it can be disposed of . <br /> e Hinsate Hauler and permitted Treatment.Storage&DtspesW FROAW.. <br /> HaalerName Same as #6 Ranier Registr%dont <br /> Address City Zip <br /> Pbone No.I_ <br /> Permitted Disposal Stte Americlean Inc. 2570 Almond Dr. , Silver Springs, <br /> NV. or other approved facility. <br /> EH 22 Cos (Revised 08715199) Page 4 <br />