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1• (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? <br />(b) Is the current certificate of worker's compensationYES ISI- NO <br />insurance on file? . YES [ NO � <br />(c) Does the contractor possess a "Bazand-as Substance Removal Certification"? YES W NO <br />(d) Has everyone on site, including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES f e NO f 1 <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? <br />YES f 1 NO [ I <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A I I YES I I NO I I If YES, Permit # <br />4• Has the contractor obtained approval from the local fire department to perform tank cutting? NAYESI I NO <br />,V <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES I I N010 <br />6. If tank residual exists, ttidentify transporting hazardous waste hauler: <br />Name C(`1 f.LS2n'nL Hauler Registration #- <br />Address 2Ss� PC, (�(� B� �� City—Ric � rano j _ Zip q WN <br />Phone <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES 0 NO f I <br />b. Identify contractor performing decontamination: <br />Name _. X Sn�� �on��-• Inc. <br />Address �: J, tti7[�X 1 t (o� City v Zip <br />Phone No.(�(� -Ct <br />C. Describe method to be used for decontamination: <br />k w e' cn 0, <br />V C <br />d. Describe how rinsate material will be stored onsite prior to manifesting of(site: t,-,) <br />n <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name ��lG �✓G�i , I,,, . <br />Hauler Registration # C00. 182036173 <br />Address City i&4o d/ `-f8n I <br />Zip <br />Phone No. <br />Permitted Disposal SiteIG�%�—`''"1 <br />EH 23 046 5/20 <br />(Revised 9/11/96) Page 4 <br />