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1. (a) Is there a PHS-F.IID contractor's questionnaire on file or enclosed? YES hl NO I I (b) Is the current certificate of worker's compensation Insurance on Ne? YES NO ( I (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES NO ( i (d) Has everyone on site, Including crane/backhoe operator, been certified to work on hazardous waste site In accordance with CCR Title 9? YES NO I I 2. Iles ■ "Slit Health & Safety Plaa" for this job site been submitted? YES NO I I 3. list applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A K YES ( I NO I I If YES, Permit N upon approval 4. ling the contractor obtained approval from the local fire department to perform tank cutting? NA( I YES( I N004 S. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (if yes, please explain) YES ( I NO 6. If lank residonl exists, Identify transporting hatardous waste hauler: Name Nor Cal Waste Oil haulers Hauler Registration it CAD 982417255 Address P. 0. Box 645 _ city Denair, CA Zip 95316 rhone a ( 800 ) 332-8710 7. Decontamination Proeedares: A. Will tank(s) and piping be decontaminated prior to removal? YES DQ NO I I h. Identify contractor performing decontamination: Name Jim Thorpe Oil , Inc. _ Address P. 0. Box 357 City Lodi Zip 95241-0357 Phone No.( 209 ) 368-6175 C. Describe method to be used for decontamination: Tank(s) and piping will be triple rinsed with a biodegradable soap solution -and hot water. it. Describe how rinsste material will be stored onsile prior to manifesting offsite: Ninsate will bither be removed from the tank by the waste oil hauler while the tank and lines are being rinsed or stored in labled and sealed drums ons to until they can be removed to a proper disposal facility. e. Rinsale Ilouler and permitted Treatment, Storage & Disposal Facility: Hauler Name same as N6 Hauler ReZistration M Address City Zip Phone No. ) Permitted Disposal site Americlean, Inc. 2570 Almond Dr. , Silver Springs , NV 89429 s/2o Ell 23 046 (Revised 9/11/96) Page 4