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(a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES M NO[] <br />(b) Is the current certificate of worker's compensation insurance on file? YES DQ NO[] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES 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 NO[] <br />Hasa "Site Health & Safety Plan" for this job site been submitted? YES I I NO P4 <br />M <br />Has applicant performing removal in the City of obtained a "Grading and Excavation Permit"? <br />N/A [ ] YES [ ] NO pQ If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NASI YFSI ] VO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain(I SE ] NO [ J <br />SSP_ reQor !s Ser, - Ago <br />If tank residual exists. Identify transporting hazardous waste hauler. <br />Name k v� /�,wu e�C w . Hauler Registration # O_U 8 <br />Address_P 6. 401 City U) •• zip Cls/ <br />Phone # ( q 1& )37/ — 5-7!T % <br />Decontamination Procedures. <br />a. Will tank(s) and piping be decontaminated prior to removal? YES)/ NO [ ] <br />b. Identify contractor performing decontamination. <br />GM <br />Name e,��. s.�• <br />Address/ ♦zip i <br />Phone , r <br />Rinsate Sauter and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />_. CRY W.ZIP• <br />Phone' <br />Permitted Disposal � . <br />:f:' 23 046r 1011W Page 4 <br />