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1, (a) Is there a PIIS-EfID contractor's questionnaire on file or enclosed7 YES NO [ j <br /> (b) is The current certificate of worker's compensation Insurance on (lie? YES NO [ j <br /> (c) Does the contractor possess a "hazardous Substance Removal Cerillicadon"7 YES NO I ] <br /> (d), flag everyone on site, including crane/backhoe operator, been certifled <br /> to work on hazardous waste site In accordance with CCR Title til 1(ES NO [ j <br /> 2. flag a "Silt Health d: Safety Plan" for this job site been submitted? YES NO [ <br /> 3. flag applicant performing removal In the City of Tracy obtained a "Grading and E:cavatioo Permit"? <br /> NIA1 YES I I NO I l If YES, Permit # !pen ap royal <br /> 4, flag the contractor obtained approval from The local fire department to perform tante cutting? NA[ I YES[ I NON <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (if yes, please explain) YES I I NO IN <br /> 6. If tank raildual esists, identify transporting hazardous waste hauler: <br /> Name Nor Cal Waste Oil Haulers ' Hauler Registration ill CAD 982417255 <br /> Address <br /> P. 0. Box 645 City Denair, CA Zip 95316 <br /> Phone # 8( 00 332-8710 <br /> 7. Decontamination Procedures; <br /> e. Will lank(s) and piping be decontaminated prior to removal? YES NO I j <br /> b. Identify contractor performing decontamination: <br /> Name dim Thorpe Oil , Inc. <br /> Address <br /> 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 /> Water- <br /> d. Describe how rinsate material will be stored onsite prior to manifesting 4ffslte: <br /> IZinsate will hither be removed from the tank the waste oil' hauler�yhiile <br /> ^the tank and lines are beinq rinsed or 5tored in lab ed and sealed drums <br /> on site until they can be removed ,to a proper disposal facility. <br /> e. Rinsate hauler and permlikd Treatment, Storage do Disposal (facility; <br /> Hauler Name same as #6 lbuler Registration N <br /> Address City zip <br /> Phone No. ( ) <br /> Permitted Disposal site Americlean, Inc. 2570 Almond Dr. , Silver Springs , NV 89429 <br /> 5/20 <br /> Ell 23 046 (Revised 9/11196) Page 4 <br />