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1.2;18/98 FRI 09::30 FAX 5106096304 RIIL DESIGN GROUP RAL PETALUMA (a005 <br /> 1. (a) Is there a PH&EHD contractor's and subcontractor's questionnaire on file or enclosed? YES NO(] <br /> (h) Is the current certificate of worker's compensation insurance an file? YES[> NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES K 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 I NO[] <br /> 2. Has a"Site Health&Safety Plan"for this fob site been submitted? YES[] NOW <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N1A�,j, YES[] NO[) If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NASI]YES(]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES j] NO[] <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name Crura, OV e.g--r on) Hauler Registration# 007,G <br /> Address 8'430 Amckkq ST, City Oakla,ti Zip 9 q(OZl <br /> Phone#( 15 ID , (0 3 3- 03 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[� NO(] <br /> b. Identify contractor performing decontamination: <br /> i <br /> Name Lfo5iol O�E2To,-• <br /> Address Srr city 0 u k.tca rn zip 14(62-/ <br /> Phone No.( 3 3 le <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> A Q+5 T',-�r e <br /> e. Rinsate Hauler and permitted Treatment.Storage&Disposal Facility: <br /> Hauler Name C J'05 b�, OJe.,r 0 1 Hauler Registration# 00 2S <br /> Address See ab 00e city Zip <br /> Phone No.{ ) 5.o e- a b o,&P- <br /> Permitted Disposal Site 1 b30 W, 171h 5T LJn6 13=4c� CA 9 0 813 <br /> EH 23 046 (Revised 10119198) Page 4 ' <br />