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9 0 <br /> 1. (a) Is there a PHS•EHD contractor's and sabco is questionnaire an Me or enclosed? YES(J NO[] <br /> (b) Is the current certificate of worker's compensation insurance on rue? YES(] NW <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO <br /> (d) Has everyone on site,including cranelbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? NO f l <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YE NO <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Elcavation Permit"? <br /> NIA(J YES(J N It YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank catling? J N <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (It yes,please explain)YES(J N8-�, <br /> G. if tank residual exists.Identify transporting hazardous waste hauler: <br /> Name L oveg ter j Hauler Registration# ZS <br /> Address_& O f"�'_,CLJ cfty 'Q P Zip <br /> Phone#( 7 Lo <br /> 7. Decontamination Procedures: <br /> a. Will s)and piping be decontaminated prior to removal? YES NO f] <br /> b. Identify contractor performing decontamination: <br /> Name Sim( <br /> Address City . O Zip_ Z•� <br /> Phone No.(t5 )0 ) !'D j 225(► <br /> r <br /> C. Describe method to be used for decontamination: <br /> iyuE Z J�j <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> �5,�'TE WP19A. I�iS'f FSE �aT.o bN'S AGE . . <br /> e. Rinsate Ranier and permitted Treatment.Storage&Disposal Facility: <br /> Hauler Name 5 i3--1 Ranier Registration#--� _ <br /> AddressALA,D ±YeUAcSl' alp OA-J::f L611 0 ap Z1 <br /> Phone No.( 512 ) Oak d <br /> Permitted Disposal Site M I,,, Cj j4M- , Zoe2f &n:1 C.LH o A-tzAD <br /> EH 23 046 (Revised 10119PA Page 4 <br />