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I <br /> 1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[J 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[] NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES M NO[] <br /> 2. Has a"Site Health&Safety Plan"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 /> NIA[] YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAN YES[]NO[J <br /> 5. Is there knowledge or evidence of leakage from the tanks)andlor plping? of yes,please explain)YES[I NO$J <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name See Attachment _Hauler Registration# <br /> ' Address City Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Cpp A-t2lttJ1npnt <br /> Address City Ztp— <br /> Phone No.( ] <br /> C. Describe method to be used for decontamination: <br /> IL Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Faclffty: <br /> Hauler Name See Attachment Hauler Registration <br /> Address City Zip <br /> Phone No.( ) <br /> Permitted Dlsnosal Site <br /> EH 23 046 (Revised 08113199) Page 4 <br />