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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES [ ] NO [a� <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 j�'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 [ ] <br /> 3. Has app 'cant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"' <br /> N/A [ YES [ ] NO [ ] If YES, Permit <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? 4A[W'VESJ ] NO] ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO l�f <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> NameHauler Registration # <br /> Address gwu City-Up"reme Zip <br /> Phone f741-Zn-- <br /> 7. <br /> -Z7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YESO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name a� <br /> Address d O . 1,1410d City -57-zeky Y _ Zip <br /> Phone No. <br /> C. Describe metho to be used for decontamination: <br /> d. Des -be how rinsate material will be stored o site prior to manifesting offsite: <br /> Cc. A uc ,u <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: 00 k <br /> Hauler Name Sn- St•1IF-4 Hauler Registration <br /> Address rte_ 3I A. Lt7L1 .S City Zip qsS� � 4-3 <br /> -- <br /> Phone No. ( <br /> Permitted Disposal Site SSU . <br /> 5/20 <br /> EH 23 046 (Revised 9/11/96) Page 4 <br />