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A <br /> 1. (a) is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES 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 W 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 K/NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES[,(NO[] <br /> 3. Hasap licant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA 7 YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAf YES[]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (if yes,please explain)YES[] NO[ <br /> 6. If tank residual exists,identify transporting <br /> 'hazardous <br /> �waste hauler: <br /> Name k VAL�-t 1 Hauler Registration# ' <br /> Q q� <br /> Address 10 1 t>� 4�.fl City �� Zip 1 � <br /> Phone#I qVb ) 3 - 5 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES{/NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address I CU City zip <br /> Phone No.{ <br /> C. Describe method to be used for decontamin on: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> A -1 VY <br /> 314J <br /> Hauler Name Hauleregsr <br /> Address 161C3 city ML41 ) (A' zip 1 <br /> Phone No. 3r2- <br /> Permitted Disposal Site—V W STV,.101 L, th t J *L�s) <br /> EH 23 046 (Revised 08113199) Page 4 <br />