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i <br /> i <br /> I 1. (a) is there aPHS-EHO contractor's and subcontractor's questionnaire on tyle or enclosed? YES NO ( ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES (}� NO [ ] <br /> (c) Does the contractor possess a " Hazardous Substance Removal Certification" ? YES NO [ j <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 [ ) <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit" ? <br /> NIAYES [ ] 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 tank(s) and/or piping? (If yes, please explain) YES [ ] N0 <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler. <br /> Name Allied Petroleum Hauler Registration # 1158 <br /> Address P . O . Box 193 city Modesto Zip 95352 <br /> Phone # ( 209 ) 576- 8500 <br /> 7, Decontamination Procedures: <br /> a. Will tanks) and piping be decontaminated prior to removal? YES H NO ( j <br /> b. Identify contractor performing decontamination: <br /> Name SEMCO <br /> Address 1217 South 7th Street City Modesto 71p 95351 <br /> Phone No{ 209 ) 524- 9653 <br /> c. Describe method to be used for decontamination <br /> The tanks & - piping will be triple rinsed at 180 ° using a low volume , <br /> high pressure washer . The first rinse will include the use of a bio— <br /> degradable detergent . The two final rinses will be clean water . <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> The rinsate material will be stored on site in DOT 55 gallon drums <br /> rh apnpnpri ata 1 nhal s <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal FacUIty: <br /> Hauler Name Allied Petroleum Hauler Registration # 1158 <br /> Address P . O . Box 193 City Modesto ZIp 95352 <br /> Phone No, 209 ) 576-8500 <br /> Permitted Disposal Site Americlean - Silver SPrings , IW <br /> EH 23 046 (Revised 10119198) Page 4 <br />