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i <br /> 1. (a) Is there a PHS-EHD contractor's and subcontractoYs questionnaire on file or enclosed? YES V(OeNO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES ] r NO [ ] <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 NO [ ] <br /> 2. Has a " Site Health & Safety Plan" for this job site been submitted? YES NO [ J <br /> 3. Has apPt <br /> t performing removal in the City of Tracy obtained a "Grading and Excavation Permit" ? <br /> N/Aiq YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[V99r1 NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES ] <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler. <br /> Name A jytef 1G tzV ft'lY`�r�P V I �,aiALMJ 7i&auler Registration #� <br /> Address�b C 3YC? cityt { } 1 Zip <br /> Phone # ( Aoc) ] '732 q4 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES NO [ ] <br /> b. Identify contractor performing decontamination: r <br /> Name <br /> AddresA06 MG , 4/� /ID/ / CitycSgD ,Lk .t.9 Zip � � J <br /> Phone No.( ZO% A33� <br /> c. Describe method to be used for decontamination: <br /> is `TI, l P UF,-- Qke%. ,SL, <br /> i <br /> d. Dsss��cribe how rinsate material will be stored onsite prior to manileesting offsite: <br /> 000 <br /> til t. TAT-F_ W I tL �� . I In t/a[F/1 1 �)`RC-fy s Tff <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Faculty: <br /> Hauler Name �/Y,[f4e1, A,c) ALey6V/(1pkJ{r2,ii7lgaulerReglstrattou #,3qYL/ <br /> i Address _ �C 3�f� city E{-[ Zip <br /> f Phone No. (961D <br /> Permitted Disposal Site�Q a4L� �K U[ CFS <br /> 1706 , iso s? <br /> EH 23 046 (Revised 10119198) Page 4 <br />