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1. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? YES X NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [J NO ( ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES Pq' NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES 04 NO [ ] <br /> 3. Has applic nt performing removal in the City of Tracy obtained a 'Grading and Excavation Permit*? <br /> N/A W YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAVYES[ ] 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 14e,&J,!5�d /E'T/Lc7GCUHj Hauler Registration <br /> Address A0- 1�;et /93 City zip 95-55-Z <br /> Phone # Zc Jq <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 5 /11 co <br /> Address �2/� .STK �' ' S'z���7 City /*OE,fro zip 9S3S/ <br /> Phone No.( 209 ) SLAG 9653 <br /> C. Describe method to be used for decontamination: <br /> TNF q?/e5 AND 1/,'11116 &1146 JOE /PLS elti$GL 1j7 /�}D°USS f 6 f? Lpl tJ <br /> (/OGU ftr, /bN /�tE55u eE C�ASs/E e, T�fe GrR$r *ASE L.iICL zLGLuoE 77f6 aSE 0� <br /> A ff/D DG6�ilDEAF3LE OETeP6EvT T/{r!�- Tu0 vqG /?W FS W/ez, Ac a it, Lvr'!E/L <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> 7T/G A1vSA7E O. PiAG !u/CG B6- 57-02EO OtiS/zE /N &7 /�C S$ 64LC Oi(j <br /> PPUhi S V/7& 94i4o/Tl,"E GAheLs <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name—ALL/EO 14771206EU/y! Hauler Registration # //SB <br /> Address /-i 0i 9w /93 City XDOESTb zip �s35-2 <br /> Phone No. ( ZOf ] 5n ei. ar Q <br /> Permitted Disposal Site �ECIN�R�J sECd/[-ES ��f'7`TE�Q,fD/t�, 64— <br /> Page 4 <br />