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1 I ' <br /> 1• (a) Is there a PHS-EHD contractor's and subcontractors questionnaire on file or enclosed? <br /> (b) Is the current certificate of worker's compensation insurance an file? YES[`1'YES[+-No <br /> NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? (J <br /> YES[YNO <br /> (d) Has everyone on site,including crane/backhoe operator,been certified [] <br /> to work on hazardous waste site In accordance with CCR Title 8? <br /> YES[.YNO[] <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? <br /> YES"O(J <br /> 3. Has app cant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[q YES[J No[] If YES, Permit N <br /> 9. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[q1i'S[J NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO[}� <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name EcoLOGy CotJrAOL /NDVST/LtE <br /> $ Hauler Registration d 1S3 3 <br /> Address 255 PARK gL. City(ZlcikmorlD Zip 14801 <br /> PhoneN r7( 0 1 L35 ('jR 3 <br /> 7. Decontamination Procedures: <br /> a. will tank(s)and piping be decontaminated prior to removal? YES[I,}'NO[] <br /> b. Identify contractor performing decontamination: <br /> Name JN5 Co//STAVc-rt o /l <br /> Address 1200 E. SHAW city C L�o V l 5 zip 13 6 11 <br /> Phone No 2( d 1 1 <br /> C. Describe method to be used for decontamination: <br /> TRIPLE tz �sE <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> _ PIkEoTLy (NTo VAcuvm T-AucK-- <br /> e. Rlusate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name eco` oGy CONTROL IN DUSTAICS15 33 <br /> Hauler Registration N <br /> Address 255 City R/cHmoND 7AP 14TO <br /> Phone No.( 0 1 235 393 <br /> Permitted Disposal Site >=co(-oGy CONTR,L IND 05rRjr_5 <br /> EH 23 D46 (Revised 10/19198) Page 4 <br />