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10/17/2000' 09:00 2094683613 FIFTH FLOOR PAGE 04 <br /> L (a) 1s there e,pH&SHD coZuactor.s and subcontractor'N questionnalre on fiie or enclosed? <br /> (b) Is the current certificate of worker's eompensatloa Insurance as tile? Y&4(1 NOW <br /> (e) Does the contractor possess a"Haasrdaas Subatguc:e Removal Certt&ettoa"? YES fU Na f I <br /> (d) Has everyone on site,including cran"ackhoe operator,been certified YE5k1 No[l <br /> to work oa hazardous waste site In accordance with CCR Title 8? YES k1 N0 ti <br /> 2. Has a"Site Heelth&3aferr Plan"for this fob site been submitted? YES(4 11011 <br /> 3. Has applicant performing removal in the City of Tracy obtabled a"Grading and Ei Myatton Permit"? <br /> Nh1 J YES(1 NO(l If YES, Permit# <br /> 4. Has the contractor obtained approval from the Intal fire department to perform tank cutting?NA[1 YESk1 N0l1 <br /> S. is there knowledge or evidence of leakage from the tanks)aadlor piping? (If yes,please explain)YES(I NO W <br /> 6. If tank residual exists,identity transporting hazardous waste hauler: <br /> Name Hauler Registration F <br /> Address Clty Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YES11 No I1 <br /> b. Identify contractor performing decontamination: <br /> Name L.I A rQArr. rnIC <br /> Address 6940 TRFMONT RD. City DIXON ZIP Q5687 <br /> Phone No� 7r!Z 469-3-2929 <br /> C. Describe method to be used for decontamination: <br /> TRTDI F R"SE TAAI IlC RUMP OUT <br /> nr <br /> NSATE AND SINE !N <br /> _DRUMS <br /> d. Desatlbe Bow Ansate 09lr W WIH be atoned Vaslte prior to lttaolteatlag olAdise <br /> RINSATE WILL BE STORED ON SITF TN n n T ' NION—APPROVED <br /> DRUMS EQP APPROXTMAIELEY ere—(!) .WEEK <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Faditr: <br /> Hauler Name_ I Hauler Registration d <br /> Address city ZIp <br /> Phone No.( ) <br /> Permitted Disposal site <br /> ER E3 046 (Revised 08(13199) Page 4 <br />