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yESM NO11 <br /> 1. (a) Is there a PHS-$HD contractor's and subcontractuNs questionnaire OIL file or enclosed? YES jq NO[1 <br /> (b) Is the current certiffeate of worker's compensation Insurance on file? YES Iq NO[) <br /> (c) Does the contractor Possess a"Hazatdnus Substance Removal CerocatWe? <br /> (d) Has everyone on site,Including cranelbackhoe operator,been certified ygS jq NO[I <br /> to work on hazardous waste site in accordance with CGR Title 87 <br /> 2- Has a"fie Health&Safety Flag"for this Job site been submitted? <br /> YBst NO[I <br /> applicant performing removal in the City of Tracy obtained a." and Excavation Permit"? <br /> 8. Has ItyES, Permit# <br /> NIA`I, YES[I NO I <br /> d. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[ I Nfl[I <br /> a is there knowledge or evidence of leakage from the tanks)andlor piping? (f yes,please explain)yEVJ NO[I <br /> s. It tank residual exists,identify transporting hazardous waste hauler _ �� <br /> ! --�y 'haste Oil Hauler�erge m# <br /> Name CSL 000827878 <br /> pm�rican Valley - <br /> - —-p.0. Box 340 -_ city Delhi, CA Zip 95315 <br /> Address <br /> 800 332-8710 <br /> Phone# <br /> 7. DecontaminationPncsdmes: <br /> a. Will tanks)and piping <br /> be decontaminated prior to removal? YE= NO[I <br /> b. Identity contractor performing decontamination: <br /> Name Jim Ther-pe Oil , Inc . <br /> P .O. Box 357 qty Lodi , CA Zip 95241-0357 <br /> Address <br /> Phone No209 368-6175 <br /> .(�� <br /> c. Describe method to be used for decontamination: 1 ut ion <br /> Tank( s) will be tri le rinsed with a biode-radea ar way <br /> and hot water. The associated lines will be done in a <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinseate will either be removed from the tarok and lines as they a-T <br /> 1:o until <br /> they can be pumped out . <br /> e. Rimate Hauler and permitted Treatment;Storage Disposal Fadllty <br /> HauIerNameAmerican Valle W.O . Haulers HanlerR8g1str1il1M# CAL 000827878 <br /> Address P.O. Box 340 -- <br /> City Delhi, CA Zip 95315 <br /> Phone Nu. 8(r0 3 3 2-8 719 <br /> Permitted Disposal Site Americlean Inc . 2570 Almond Dr. Silver S rings 1 <br /> or other approved facility. <br />