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0 <br /> 1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES . NO <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [ J NO [ <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? 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 /> N/A [I YES [ ] NO [ I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAV,] YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ) NO. <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name H & H Shipping Hauler Registration #GFQ36-017353 <br /> Address 220 China Basin CitySan Francisco Zip 94107 <br /> Phone # ( 415 ) 543-4835 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ J NO JA <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Hauler Registration# <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />