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0 <br />1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire an flle or enclosed? <br />(b) Is the current certificate of worker's compensation insurance on flle7 <br />(c) Does the contractor possess a "Hazardous Substance Removal Certiflcatlon"? <br />(d) Has everyone an site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />2. <br />3. <br />4. <br />5. <br />6 <br />7 <br />Has a "Site Health & Safety Plan" for this Job site been submitted? <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA [)` YES [ ] No [ ] If YES, Permit N <br />YES W NO[] <br />YES( NO[] <br />YES W NO[] <br />YES W NO [ ] <br />YES( NO(] <br />Has the contractor obtained approval from the local fire department to perform tank cuWng? NWYES[ ] NO( ] <br />Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES [ J NO,pj <br />If tank residual exists, Identify transporting hazardous waste hauler. <br />Name Allied Petroleum <br />Address P.O. Box 193 <br />Phone M( 209 1 576-8500 <br />Decontamination Procedures: <br />Hauler Registration # 1158 <br />City Modesto Zip 95352 <br />a. Will tank(s) and piping be decontaminated prior to removal? YES H NO [ ] <br />b. Identify contractor performing decontamination: <br />Name <br />Address 1217 South 7th Street Cyt, Modesto Zip 95351 <br />Phone No 209 1 524-9653 <br />c. Describe method to be used for decontamination: <br />The tanks &-piping will be triple rinsed at 180° using a low volume, <br />degradable detergent. The two final rinses will be clean water. <br />d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br />The rinsate material will be stored on site in DOT 55 gallon drums <br />seri Yh <br />apprnprjato 1 aha! G <br />e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility <br />Hauler Name Allied Petroleum Hauler Registration# 1158 <br />Address P.O. Box 193 <br />Phone No. ( 209 1 576-8500 <br />Cit, Modesto Zip 95352 <br />Permitted Disposal Site Americlean - Silver SPrings, NV <br />EH 23 046 (Revised 10119198) Page 4 <br />