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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed:' YES N NO(] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES N NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO[1 <br /> (d) Has everyone on site,including craneibackhoe 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 /> NIAX YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting. NAMES[]NO[] <br /> 5. Is there knowledge or evidence of leakage ttam the tank(s1 and/or oigiu�' Tf„o� c'.c�se e Yl�i„^)YES[] NMR- <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Lly <br /> Name American Valley Waste Oil HauIerHauler Registration# CAL 000827878 <br /> Address P.O. Box 340 City Delhi , CA Zip 95315 <br /> Phone#( 800 ) 332-8710 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YEgj� NO[] <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil , Inc . <br /> Address P.O. Box 357 City Lodi , CA 71p 95241-0307 <br /> Phone No.( 209 ] 368-617 <br /> C. Describe method to be used for decontamination: <br /> Tank(s) will be triple rinsed with a biodegradeable soap so ution <br /> and hot water . The associated lines will be done in a similar way. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Rinseate will either be removed from the tank and lines as they are <br /> hei ng ri ngeri by the vast- haul a nrg�gr_gd j_} Scccse�, ahl Pct until <br /> they can be pumped out . <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility. <br /> Hauler NameAmerican Valley W.O. Haulers Hauler Registration# CAL 000827878 <br /> Address P.O. Box 340 City Delhi , CA Zip 9531 <br /> PhoneNo.( 800 332-8719 <br /> Permitted Disposal Site Americlean , Inc 2570 Almond Dr. , Silver Springs , NV <br /> or other approved facility . <br /> EH 23 046 (Revised 08113199) Page 4 <br />