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1. (a) Is there a EHD contractors and subcontractor' questionnaire on file or enclosed? .J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES No <br /> YES [] <br /> (e) Does the contractor possess a"H,urdous Substance Removal NO <br /> Certificatioa"? [ <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on YES NO(j <br /> bazardous waste site in accordance with CCR Title 8? <br /> YES No <br /> 2. Has a"Site Health&Safety Plan" for this job site been submitted? <br /> YESX NO[j <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit',? <br /> N/AX YES[] 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 tanks)and/or piping? (if yes,please explain)YES[] NO`S <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name1�Znn.�C .� " �� S2aulerRegistration# <br /> Address 6 D 3 City U�L J Zip <br /> Phone# 0 0 3 . <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? <br /> Y-F-SX NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address—1�"g Nc� . City /�/(�>I Zip <br /> Phone No.(� z s <br /> C, Describe method to e used for decontamination: <br /> 16 <br /> d. DZ��how rins to ma�ial will be stored onsite prior to manifestin offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name /Cc�O'f/ t/G Hauler Regi <br /> stration# <br /> Address _ CityZip f> /5- <br /> Phone No. <br /> Permitted Disposal Site MO 11/,1g. I <br /> 5�c/161 Y7� <br /> 8. a. Describe the method that will be utilized to purge and/oinert htank(s): y 5 <br /> b. Tank/Piping Hauler: <br /> Name _ i2 'O- <br /> EH 23 046 (Revised 12/31/07) 4 <br />