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1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES)4 NO(] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES J4 NO(] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES R NO[) <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? YESIK NO[] <br /> 2. Has a"Site Health&Safety Plan" for this Job site been submitted? YES (] NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA YES[] NO[] If YES, Permit N <br /> 4 Has the contractor obtained approval from the local fire department to perform tank cutting?N*YES[]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 \ Hauler Registration M <br /> Address �����V�_ CityZIP <br /> Phone M <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 Q�.� <br /> Address City Zip t0J <br /> Phone No.(_�\� <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> L��ft <br /> e. Rinsate Hauler and permitted Treatment.Storage&Disposal Facility: <br /> Hauler Name Hauler Registration M <br /> Address City \ ���� Zip qqnbl <br /> Phone No. <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 10119198) Page 4 <br />