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6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name r _ Hauler Registration # CA) O 09 Y66 39' 2 <br />Address_ 25-5- PA(ZIK &\/D ^ity (LIa4 MON �i Zip qq &01 <br />Phone # , 510 _) 23S - f 3013 <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] N <br />b. Identify contractor performing decontamination: <br />Name <br />Address City <br />Phone No.(-) <br />C. Describe method to be used for decontarn on: <br />d. Describe how rinsate <br />e. Rinsate Hauler an <br />Hauler Name <br />Address <br />Phon 0.( <br />Pe 'tted Disposal S <br />EH 23 046 (Revised 8/9/06) <br />Zip <br />be stored onsite prior to manifesting offsite: <br />Treatment, Storage & Disposal Facility: <br />Hauler Registration # <br />City Zip - <br />4 <br />1. <br />(a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? <br />YES jxj <br />NO j ] <br />(b) Is the current certificate of worker's compensation insurance on file? <br />YES [ ] <br />NO [� <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />YES [(] <br />NO [ ] <br />(d) Has everyone on site, including crane/backhoe operator, been certified to work on <br />(e) hazardous waste site in accordance with CCR Title 8? <br />YES)] <br />NO [ ] <br />2. <br />Has a "Site Health & Safety Plan" for this job site been submitted? <br />YES 14 <br />NO <br />3. <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation <br />Permit"? <br />N/ A KJ YES [ ] NO [ ] If YES, Permit # <br />4. <br />Has the contractor obtained approval from the local fire department to perform tank cutting? <br />NAx] YES[ ] NO[ ] <br />5. <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] <br />NO <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name r _ Hauler Registration # CA) O 09 Y66 39' 2 <br />Address_ 25-5- PA(ZIK &\/D ^ity (LIa4 MON �i Zip qq &01 <br />Phone # , 510 _) 23S - f 3013 <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] N <br />b. Identify contractor performing decontamination: <br />Name <br />Address City <br />Phone No.(-) <br />C. Describe method to be used for decontarn on: <br />d. Describe how rinsate <br />e. Rinsate Hauler an <br />Hauler Name <br />Address <br />Phon 0.( <br />Pe 'tted Disposal S <br />EH 23 046 (Revised 8/9/06) <br />Zip <br />be stored onsite prior to manifesting offsite: <br />Treatment, Storage & Disposal Facility: <br />Hauler Registration # <br />City Zip - <br />4 <br />