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' � c= tiloVhL (u6jC2/•!<--i0Q To j3G DG'RYlMINL:v <br /> 1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES K NO[] <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES W NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESX NO(i <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YESM NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YESO$ , NO(J <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> Nl� YES(j NO[] It YES, Permit H <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[J YE-'KNgK <br /> 5. Is there knowledge or evidence of leakage from the tanks)and/or piping? (If yes,please explain)YES[J N <br /> 6. It tank residual exists,Identify transporting hazardous waste hauler. <br /> Name?i0LWP< CANS?o0.T4-Tt,)rj 'F�CML=tnhir $aulerReglsttatlonM O(o�5`f749 E <br /> Address P.(). Fcj( 1150 city Sh>v MAr`_j_),J Zip 96oe"-6 <br /> I <br /> Phone M( X00 j �-2— ( U jci <br /> 7. Decontaminatlon Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YBS NO J) <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address 41b2� 5. lei. ?_Ala— /I City_zt �s6 eo zip 9'39zs <br /> Phone No.( St59 )_,j ig 23? - 3?dV <br /> C. Describe method to be used for decontamination: <br /> FLuSN PtP/MCr /A/4D ZxiT—.4JFRVWV /KS o!2 <br /> ���� HAZA2Dous �xJAS-r� HA,uL6,e T/4nrK�mA,",51�.+er ' <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> N�ia SH/pp6o SAME c?gy <br /> e. Rlnsate Hauler and permittedTreatment,Storage&Disposal Facility. <br /> HaulerName r 1 -v K Hauler Registration#r4 p®(p3s�/i/Q9lo <br /> Address F O. Sox Iso city 5•au Mae?/A/ zip S�oy6 <br /> Phone No.(S&-C32/— !t73o <br /> Permitted Disposal Site eA&; dl44t. rllgsr-E /l�,Qy/j�t�E�{ �✓�JT/.�/�/.4r� <br /> EH 23 046 (Revised 08113199) Page 4 <br />