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r. <br /> 1. (a) Is there a PHS-EIID contractor's questionnaire on Ole or enclosed? YES hl NO <br /> (h) Is the current certificate of worker's compensation Insurance on Ole? YES NO j <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certillesdoe"? YES NO <br /> (d) Hof everyone on site, Including crane/backhoe operator, been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES NO ( j <br /> 2. Iles a "Site Health & Safety Plan" for this job site been submitted? YES NO ( i <br /> J. ling`ap�'Ilcant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A p9 YES ( I NO If YES, Permit N upon approval <br /> 4. lies//the contractor obtained approval from the local fire department to perform lank cutting? NA( I YES[ 1 NON <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain) YES j NON <br /> 6. If lank residual exists, Identify transporting hazardous waste hauler: <br /> Nome Nor Cal Waste Oil Haulers Hauler Registration N CAD 982417255 <br /> Address P. 0. Box 645 City Denair, CA Zlp 95316 <br /> Phone q ( 800 ) 332-8710 <br /> 7. Decontamination Procedures: <br /> s. Will lank(g) and piping be decontaminated prior to removal? YES DQ NO 1 <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc. <br /> Address P. 0. Box 357 City Lodi Zip 95241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> C. Describe method to be used for decontamination: <br /> Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br /> -and hest water_ <br /> d. Describe how rinsete material will be stored onsite prior to manifesting gffsite: <br /> Rinsate will bither be removed from the tank by the waste oil hauler while <br /> the tank and lines are being rinsed or stQred in labled and sealed drums <br /> ons to unt 1 they can be removed to a proper disposal facility. <br /> e. Rlnsale Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name same as N6 Hauler Registration N <br /> Address City Zip <br /> Phone No. ) <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , SilVer Springs , NV 89429 <br /> s/2o <br /> Ell 23 046 (Revised 9/11/96) Page 4 <br />