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I <br />I, (a) Is there a PIIS-F.IID contractor's questionnaire on OYES NJ NO Ile or enclosed? YES NO ( ( <br />(b) Is the current certificate of worker's compensation Insurance on file? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES M NO <br />(d) Has everyone on site, including crane/backhoe operator, been certified YES QQ NO <br />to work on hazardous waste site In accordance with CCR Title 97 <br />2. Has a "Site Health do Safety Plan" for this job site been submitted? YES Ii NO I I <br />3. llns applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A/), YES ( I NO ( I If YES, Permit b upon approval <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA( I YES( I NON <br />5. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES (I NO QQ <br />6. If tank residual exists, Identify transporting hazardous waste hauler: <br />Name Nor Cal Waste Oil Haulers Hauler Registration N CAD 982417255 <br />Address P. 0. Box 645 city Denair, CA Zip 95316 <br />Phone tft 800 1 332-8710 <br />7. Decontamination Procedures: <br />R. Will tank(s) and piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name Jim Thorpe Oil, Inc. <br />Address P • 0. Box 357 <br />Phone No.t 209 1 368-6175 <br />City <br />Lodi <br />YES ;4 NO I I <br />Zip 95241-0357 <br />C. Describe method to be used for deconlaminatlon: <br />Tank(s) and piping will be triple rinsed with a biodegradable soap solution <br />d. Describe how rinsate material will he stored onsite prior to manifesting offsite: <br />Rinsate will 'either be removed from the tank by the waste oil hauler while <br />the tank and lines are being rinsed or stored in la_bled and sealed drums <br />on site until they can be removed to a proper disposal facility. <br />e. Rlnsale Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name same as #6 Hauler Registration ff <br />Address City Zip <br />Phone No. <br />Permitted Disposal Site Americlean, Inc. 2570 Almond Dr., Silver Springs, NV 89429 <br />5/20 <br />EH 23 046 (Revised 9/11/96) Poge 4 <br />