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11/02/2001 10:47 9166814Ql GEOFON INC PAGE 06 <br />1, (a) is there a FHS-EHII contractor's and subcontractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation insurance on tile? <br />(c) Does the contractor possess a "Hazardous SubstaM Removal Certiflcatiett"? <br />(d) Has everyone on site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 87 <br />YES NO[] <br />YESK Noll <br />YES No[] <br />?ESA Na[I <br />2. Has a "Site Realtb. & Safety Plan" for this job site been submitted? <br />YI&Sg No[1 <br />3, <br />Has applicant performing removal in the City of Tracy obtained q "Grading and EIcavatioR Permit"? <br />NIA [ I LIES 1 I Noll If YES, Permit # _— �-)- ?& �--- <br />4. Has the contractor obtained approval from the Weal fire department to perform tank cutting? N4YESj I NO[ [ <br />Is there knowledge or evidence of leakage from the tanks) and/or piping? (If yes. please explain) YES I I No <br />6. if tank residual exists, Identify transporting bazardous waste hauler. <br />i <br />Name lay ' Ranier Registration <br />Address� QitY_ � ZIP_ <br />Phone # (fin i 2 <br />Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to removal? YESK Noll <br />b. Identify contractor performing decontamination: <br />Name C7 . <br />Address I Aj 5 Cit? Yt Zip - <br />Phone No.( lL ....) �� <br />a, Describe method thbe used for <br />d. Describe how rinsate material will be stored onsite to mdfeoffsite: V,4 <br />r� <br />C c' sting � 1� <br />e. ilinsate Hauler and permitted Treatment, Storage & Disposal Facility: ,v7 <br />Hauler Name naler Registration 0 V <br />Address <br />ell <br />Permitted <br />Phone No. 1 ®} <br />Permitted Disposal Site . OL <br />EH 23 046 (Revised 08113199) Page 4 <br />