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E (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES [;j( NO [ ] (b) Is the current certificate of worker's compensation insurance on file? YES P4 NO [ ] (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [X NO [ ] (d) Has everyone on site, including crane/backhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES N NO[] 2. Has a "Site Health & Safety Plan" for this job site been submitted? YESJxj NO [ ] 3. Has applicant performing removal in the City of Tracy obta ed a "Grading and Excavation Permit"? NIA [ ] YES [ ] NO[] If YES, Permit # . / 4 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NM YES[ ] NO[ ] 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO I] 6. If tank residual exists, identify transporting hazardous waste hauler: 1 '�' . �=%-r �v' i� �'ii�` %'!�/if'�` [iauler Registration # (� `� Name ,i Address %°= City zip Phonefl ( 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES11 NO [ ] b. Identify contractor performing decontamination: Name Address C`�'%'� �' fi Cr' City _S'M Phone No.( `j / 6 ) /.. �-' / -'� /. C. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: j %r - 'j /✓ a / � r 1, i :.% % �. ,C_ ! i' •.;fie/ �;,; �� fi h/.T.,C; It VA - (a �i<i« f r 7 e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: 7. Hauler Name {j-�<' ' /?�=,�_ �/ !a`�'r'i/C%1 �j/��N C•. - Hauler Registration # Address i' ,;l , tom �� int / % / �' ✓ �y City �x1 E- Gni fi< ,A�f Zip c/ Phone No.( S'�' ) Cj ;2,2, `._S 2- 0 Permitted Disposal Site L' & 2. E '/1{ �� i 1 / A-1 . EH 23 046 (Revised 08113/99) Page 4