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0 0 <br /> 1 (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES ] NO[] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES-K NO[j <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> hazardous waste site in accordance with CCR Title 8? YES N NO [] <br /> 2. Has a"Site Health &Safety flan"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 [J YES[] NO [] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[] YES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NOX <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Hauler Registration# <br /> Address City Zip <br /> Phone# ( ) ---- --- <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to.removal? YES[] NO[ ] <br /> b. Identify contractor performing decontamination: <br /> Name - <br /> Address City Zip_. <br /> Phone No.( ) -- ---- - - <br /> c. Describe method to be used for decontamination: lecoRfiami o t;ok- wal . r-r ,,r tot <br /> pyo F713 Zwb as TE-m o Y cum OCEnowe - <br /> & Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted"Treatment,Storage&Disposal Facility: <br /> Hauler Name Hauler Registration# <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 11/21/06) 4 <br />