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1. a) Is there a PHS-EHD con or's questionnaire on file or enclosed? YES[X] NO[ ] <br /> b) Is the current certificate of worker's compensation insurance on file? YES[X] NO[ ] <br /> c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[ ] NO[X*] <br /> * Have received CWRCB/EPA two day course in tank closures. <br /> 2. Has a"Site Health & Safety Plan"for this job site been submitted? YES[X] NO[ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[X] YES[ ] NO[ ] If YES,Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? <br /> NA[X] YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? YES[ ] NO[X] <br /> (If yes,please explain) <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name Erickson Enterprises Hauler Registration# 0019 <br /> Address 255 Parr Blvd City Richmond,CA zip 94m1 <br /> Phone No.(510)262-1500 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES[ ] NO[X] <br /> b. Identify contractor performing decontamination: <br /> Name N/A <br /> Address_ City zip <br /> Phone No.( ) <br /> c. Describe method to be used for decontamination: <br /> N/A <br /> d. Describe how rinsate material will be stored on-site prior to manifesting off-site: <br /> N/A <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name N/A Hauler Registration# <br /> Address _City zip <br /> Phone No. <br /> Permitted Disposal Site <br /> CLOSURE PLAN: 865-DlU1 <br />