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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES M NO[] <br /> (b) is the current certificate of worker's compensation Insurance on file? YES Ig NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certiflcation"7 YES]f[ NO(] <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work an hazardous waste site In accordance with CCR Title 8? YESr] NO[] <br /> Z. Has a"Site Health&Safety Pian"for this job site been submitted? YESJ] 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# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NXUS[]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain))YES(] Nok <br /> 6. If tank residual exists,identify transporting hazardons waste hauler. <br /> Name American Valley Waste Oil Haul ergander Registration# CAL 000827878 <br /> Address P.O. Box 340 Clty Delhi, CA yip 95315 <br /> Phone#( 800 ] 332-8710 <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 Jim Therpe Oil , Inc . <br /> Address P.O. Box 357 City Lodi , CA yip 95241-0357 <br /> Phone No.( 209 ] 368-6175 <br /> C. Describe method to be used for decontamination: <br /> Tank(s) will be triple rinsed with a biodegradeable soap solution ] <br /> and hot water. The associated lines will be done in a similar way <br /> d. Describe how rinsate material will be stared onsite prior to manifesting offsite: <br /> Rinseate will either be removed from the tank and lines as they are <br /> had ngrinspfi hV tha + h i + aer i$ qpAj ed fTshl -d until <br /> they can be pumped out . <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facllity <br /> HaulerNameAmerican Valley W.O. Haulers Hauler Registration# CAL 000827878 <br /> Address P.O. Box 340 City Delhi, CA yip 95315 <br /> Phone No.( 800 ] 332-8719 <br /> Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs , NV <br /> or other approved facility. <br /> IM 94 nA„F MpAgpd roti gi091 Pwe 4 <br />