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6. If tank residual exists, identify transporting hazardous waste hauler: / <br />D (. M eJ 1 ✓1 <br />Name A -'-pt �� OV`'Hauler Registfration # <br />Address City Zip <br />Phone #( ) <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 <br />Address City Zip <br />Phone No.( ) <br />C. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Hauler Registration # <br />Address City Zip <br />Phone No.( ) <br />Permitted Disposal Site <br />5/20 <br />EH 23 046 (Revised 9/11/96) Page 4 <br />1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES,-A/NO <br />[ ] <br />(b) Isjthe current certificate of worker's compensation insurance on file? YES <br />NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES <br />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 S? YES <br />NO ( ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES ( <br />NO [ ] <br />3. Has`a�Plicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A p� YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA <br />YES[ ] NO[ ] <br />5. Is there yk\nowledgeor evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br />L'ov , 1 V`)y �\A\ <br />6. If tank residual exists, identify transporting hazardous waste hauler: / <br />D (. M eJ 1 ✓1 <br />Name A -'-pt �� OV`'Hauler Registfration # <br />Address City Zip <br />Phone #( ) <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 <br />Address City Zip <br />Phone No.( ) <br />C. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Hauler Registration # <br />Address City Zip <br />Phone No.( ) <br />Permitted Disposal Site <br />5/20 <br />EH 23 046 (Revised 9/11/96) Page 4 <br />