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i. (a) Is (here a PNS-EIID contractor's questionnaire on file or enclosed? YES e(1 NO I I <br /> (b) Is the current ceNificale of worker's compensation Insurance on nle? YES NO I 1 <br /> (c) Does the contractor possess a "►la»rdoeo Substance Removal CerliOntloa"? YES NO I I <br /> (d) Ilan everyone on life, Including crane/backhoe operator, been certified <br /> In work on hanlydous waste site In accordance with CCR Title 8? YES NO I I <br /> 2. Ilan a "Site health A Safely Plan" for this lob site been submitted? YES NO I I <br /> 3. Ilan applicant performing removal in the City of Tracy obtained a "Coding and Excavation Permit"? <br /> N/A K YES I I NO I I If YES, Permit N upon approval <br /> 4. Ilan the contractor obtained approval from the local fire department to perform lank culling? NAI I YESI I NON <br /> S. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES I I NO N <br /> 6. If Innk re4ldual exists, Identify transporting hazardous waste hailer: <br /> Name Nor Cal Waste Oil haulers hauler Registration N CAD 982417255 <br /> Address P. 0. Box 645 CityDenair, CA Zip 95316 <br /> Phone N ( 800 1 332-8710 <br /> 1. Decontamination Procedures: <br /> e. Will tank(s) and piping he decontaminated prior to removal? YES P4 NO I <br /> b. Identity contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc. <br /> Address V. 0. Dox 357 City Lodi Zip 98241-0357 <br /> Phone No.( 209 ) 368-6175 <br /> e. Describe method Ib he used for decnntaminalion: <br /> Tank(s) an"iping will be triple rinsed with a biodegradable soap solution <br /> and_hnt_water_-- --_ - — <br /> d. Describe how r(nsele material will be stored onsile prior to manifesting pfftilet <br /> Rinsate will bather be removed from the tank by the waste oil hauler while <br /> _the tank and lines are being rinsed or stored 1n labled and sealed drums <br /> on s to untiTt ey can be removed to a proper disposalac T t1 y. <br /> e. Mutate hauler end permitted Treatment, Storage & Disposal Fecllllys <br /> Moder Name sante as N6 hauler Registration N <br /> Address <br /> CIIy Zip <br /> Phone No. <br /> Permitted Disposal Slte Americlean, Inc. 2570 Almond Dr. , Silver Springs, NV 89429 <br /> Elf 23 046 (Revised 9/11/96) 5120 <br /> Pnge 4 <br />