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FRQr 1 P 5 <br /> 1. (a) Is there a PS3-EED contractor's and subcontractor's questionnaire on file or enclosed? YES E] NO E� <br /> (b) is the current certificate of worker's compensation insurance on AIe? YES tj NO[[ <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certlflcation"? YESjj NO[j <br /> (d) Has everyone on site,Including cranelhackhoe operator.been certified <br /> to work on Hazardous waste site in accordance with CCR Title 87 YES E1 NO E] <br /> 2. Has a'Site Health&Safety Plan"for this job site been submitted? hpf Rc dot YES[] NO[.)' <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA K YES[] NO[j If YES. Permit# <br /> 4. gas the contractor obtained approval from the local:'ire department to perform tank cutting?NAE]YES{]No[1 <br /> 5. Is there knowledge or evidence of leafage from the tauk(s)andfor piping? (If yes,please explain)YES[] N0;] <br /> 6. If tank residual exists,ldentlry transporting hazardous waste hauler. <br /> Name p I �tv Hauler fteglstratfon <br /> Address City Zip <br /> Phone#( } <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 City Zip <br /> Phone Nod } <br /> C. Describe method to be used for decontamination: <br /> r\ m <br /> d. Describe how rinsate material Will be stored onsite prior to manifesting offsite: <br /> e. Mmate Hauler and permitted Treame'nnt,/Storage&Disposal Facility: <br /> Hauler Name Y"' Uuler Registration# <br /> Address City Zip <br /> Phone No.( } <br /> Permlfted Disposal Site <br /> EH 23 046 (Revised 10119198) Page 4 <br />