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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES NO [ J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES NO <br /> (c) Does the contractor possess a "Haardous Substance Removal Certification"? YES NO <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 j/J' NO <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES Y' NO [ J <br /> 3. Has *apiplicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"'. <br /> .N/Ai7�/A YES ( I NO [ ( If YES, Permit # <br /> J. Has <br /> ✓the <br /> `'contractor obtained approval from the local fire department to perform tank cutting? NAXYES( NO[ <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES ( ] NO-A <br /> 6. If tank residual�exists, <br /> identify transporting � 1ha�zardous waste hauler. <br /> Name ,PrM�R�CA-�\ JArCLG Hauler Registration # 4 <br /> AddressitLp-21 <br /> 1�/�21` K 1C1>� t. 1 City Zip <br /> 115 <br /> Phone # <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES'A ;NO [ J <br /> b. Identify contractor performing decontamination: <br /> J l <br /> Name l...TC � l/Z�IJ-'1�Tt\�CA4 <br /> AddressI D (}1.�1�1�)7 Itl�,ry1 �\ City <br /> Phone No.( oM <br /> C. Describe method to be used for decors tion: <br /> :! >✓ S <br /> GL , -t- P1,LM1P1 Nlr 6T po wl r F, <br /> Aa._C314 !Env-. was ir 64 t L'E <br /> d. Describe how rinsate material 'll be stored onsite prior to manifesting offsite: <br /> RI K3rA W 1 LL Kt PUMPV7,D R,-t TIS <br /> Q -n ZZE, oN t Ll- �aF*rnidke Is P Fsiu�l <br /> e. Rinsate Hauler <br /> /and <br /> , permitted Treatment, Storage <br /> (&�Disposal <br /> Facility: 1 �, <br /> Hauler Name <br /> gA *,f '�IC�4n,\�_IU�L CQW� nri lcrRegistratioa # 3q T <br /> Address , lr�t)DD3 01`,01 ` �, C City �lS"IQ,I v Zip <br /> Phone No. (.p" ` ) -1-3 D, T104 J -�y- <br /> Permitted Disposal Site d�1wl ��L. ChaatS`��ls <br /> EH 23046 (Revised 7/10/96) Page 4 <br />