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4 <br /> 1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES;I :NO <br /> (b) Is the current certificate of worker's compensation Insurance on file? NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO[] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES[J�NO[] <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? YES[{�NO[J <br /> 3. Has ap licant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA W YES[J NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NO[� <br /> 5. Is there knowledge or evidence of leakage from the tanks)andlor piping? (If yes,please explain)YES[i/NO[J <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler: <br /> Name P �D C H c M CF•L 7NL Hauler Registration# <br /> Address U Q s 111 D -1 F i_ fit,) .- City .SA o'S D;c zip 15 1 1 .2. <br /> Phone#( <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[(NO[J <br /> b. Identify contractor performing decontamination: <br /> Name ) F' ;r (- <br /> Address I . E != `. . - t{,` City V zip i) <br /> Phone No.( .j r" <br /> c. Describe method to be used for decontamination: <br /> T \ v DR U'✓"1S <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> RimsA-i – Lj 1.3FLToa : ori Si ` Snl D..% NN APPQ�Ui-!� <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name ]V ( r ` A L —A ,), Hauler Registration# 41;Zq6 a Z <br /> Address i1 L A :. City '_ 7Ap 1 �. <br /> Phone No.( ` ) = ? S y ! L <br /> Permitted Disposal Site _'T NO A)T0 !^P <br /> EH 23 046 (Revised 08113199) Page 4 <br />