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1. (a) Is there a PHS-END contractor's and subcontractor's questionnaire on the or enclosed? YES[] NO I I <br /> (b) Is the current certificate of worker's compensation insurance on Me? YES[] NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal C on"T YES[] NO I] <br /> (d) Has everyone on site,Including crane/backhoe operator,been corned <br /> to work on hazardous waste site In accordance with CCR Title 8? YES[]/NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES M" NO[1 <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation permit"? <br /> NIA[I YES I I NO I] if YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NO[] <br /> 5. Is there knowledge or evidence of leakage from the tanks)and/or pi of yes,please explain)YES[] NO[] <br /> S. It tank residual exists,identify transporting hazardous waste hauler. <br /> Name Hauler Registration# CAD BZ 03013-3 <br /> Address Z 55 I% f Blvd _City 1ZiC M br► 21p qf q 80 l <br /> Phone#( 570 ) Z35'- 1393 <br /> 7. Decors <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES NINO[] <br /> b. Identity contractor performing decontamination: <br /> Name 7~C <br /> Address 255 P^((- (3I vd city j'Zec� 0,L d zip 9 ya l <br /> Phone No.( S i b ) 2s.5—— 1313 <br /> C. Describe me d to be used for deo do <br /> r L o rt e v <br /> r c,asa r. cc vaa <br /> d. Describe how rinsate material will be stored ansite prior to Manifesting offsite: <br /> s�at`d Ln vae uv� Jrutr `fr s fae ,h vdkc uvw. ACOLk. <br /> e. Rinsate Hauler and pe W d Treatment,Storage&Disposal Facility: <br /> EsC T -- HN. Cr <br /> Namelrs �'— 16Wtic, 6t 1CV.-t'! r 1Be nE Cl4Dd0`]ySZ6S� <br /> Address 2081 t ® Zip q q 3® <br /> Phone No.( , 3-z q - 'b38 <br /> Permitted Disposal Site CreSaY 4 Ove-Avn , LIA eas , t(3D west 1�4 $4. <br /> �jOSJb <br /> EH 23 046 (Revised 0811 Page 4 <br />