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I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES I✓I NO (b) Is the current certificate of worker's compensation insurance on file? YES I ( NO (c) Docs the contractor possess a "Hazardous Substance Removal Certification"? YES NO (d) Has everyone on site, including crane/backhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES NO I 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES I� NO ( I 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A I7 YES I ) NO I I If YES, Permit # 3. Has the contractor obtained approval from the local fire department to perform tank cutting? NA/YESI I NOIt 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES I I NO V 6. If tank residual exists, identify transporting hazardous waste hauler: Name NO`( C-0 L el"i Hauler Registration 1 Z Address ^ V O� 1Cityo-eNgifl, Zip C/,<3% Phone # Qa -13-2- 7. Dceonmmivation Procedures: / a. Will tank(s) and piping be decontaminated prior to removal? YES (V( NO I b. Identify contractor performing decontamination: Name 5 7akL-EY Cly N S T Address Ih'. Q. 16M Jeop City Yo ty Zip yS 37 t/ Phone No.(-2-0c/ )_4�3 �Z^J�� I-2— C. Describe method to be used for decontaminatiq/p: Pty 4P3a QGf�j2 I.G UL/M � Q? ' QaSP d. Describe how rinsate material will be stored onsite prior to manifesting offsite: e-UM�,gd Q ; ,�)7C 00C :aJCK e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Nam ( Name 1U1Q11rC� ^ a L & ; L Hauler Registration Address 9 D • UO1X � ��7Q City UPht7 Y t Zip7531 Phone No. (9,DO .3,3 /fi g (� Permitted Disposal Site er.G.I� -2-J 70 // 1-#0Ad lJY 5/20 EH 23 U46 (Revised 9/11/96) Page 4 Nil �11ZG