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1. (a) Is there a PHS-EIiD contractor's questionnaire on file or enclosed? YES [1 NO [ i (b) Is the current certificate of worker's compensation Insurance on tile? YES NO ( j (e) Does the contractor possess a "Hazardous Substance Removal Certif eatioa"? YES NO [ j (d). Has everyone on site, Including crane/backhoe operator, been certified to work on hazardous waste site In accordance with CCR Title 9? YES NO [ 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES NO 3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? N/A K YES ( I NO I I If YES, Permit # upon approval 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA( I YES( I NON 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ j NON 6. If tank residual exists, Identify transporting hazardous waste hauler: Name Nor Cal Waste Oil Haulers Hauler Registration N CAD 982417255 Address P• 0. Box 645 City Dena i r, CA Zip 95316 Phone N ( 800 ) 332-8110 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES NO ( I b. Identify contractor performing decontamination: Name Jim Thorpe Oil , Inc. Address P• 0. Box 357 City Lodi Zip 95241-0357 Phone No.( 209 ) 368-6175 C. Describe method to be used for decontamination: Tanks) and piping will be triple rinsed with a biodegradable soap solution and hnt water_ d. Describe how rinsate material will be stored onsite prior to manifesting Offsite: Rinsate will hither be removed from the tank by the waste oil hauler while the tank and lines are being rinsed or stored in labled and sealed drums o site until they can be removed to a proper disposal fac .l ty. e. Rinsate Hauler and permitted Treatment, Storage do Disposal Facility: Hauler Name same as #6 Hauler Registratdon N Address City Zip Phone No. ( ) Permitted Disposal Site Americlean, Inc. 2570 Almond Dr. , Silver Springs, NV 89429 S/20 Ell 23 046 (Revised 9/11/96) Page 4