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1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[] NO[j <br /> (b) Is the current certificate of worker's compensation insurance on file? YES[] NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[] NO[j <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <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(J NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[] YES(] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[J NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? Of yes,please explain)YES[] NO(] <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name EC I Hauler Registration 0SAIl9.q n 301 7 3 <br /> Address 255 Parr Boulevard CityRichmond Zip948O1 <br /> Phone#(510 ) 235-1393 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[] NO[] <br /> b. Identify contractor performing decontamination: <br /> Name ECI <br /> Address 255 Parr Boulevard CityRichmond Zip 94801 <br /> Phone No.( 51 0 ) 235-1393 <br /> C. Describe method to be used for decontamination: <br /> Vacuum truck removal of r Gidual fuel - hnt water rPcc„rP—washer <br /> and bl0ry usi nq var uum truck. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> Sued_ in ya!-mira—trade tram spor-te4 i n V-a,C,,, _truc;k <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler NamdDisposal-Romic Chi ical Corp JlanlerRegistration# C'AD0O9452657 <br /> Address 2081 Bay Road CityEast Palo AltZQ 94303 <br /> Phone No.(650 ) 324-1638 <br /> Permitted Disposal Site Co-5BY ®Yir-p-rar� <br /> EH 23 046 (Revised 08113199) Page 4 <br />