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6. <br />P. S <br />(a) Is there a PHS•EHD Contractor's and subcontractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation Insurance on file? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certlflcatian"7 <br />(d) Has everyone on site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR TlUe 87 <br />Has a "Site Health & Safety Plan" for this job site been sabmitted7 <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"7 <br />N/A ( ) YES ( j NOX If YES, Permit # <br />YES() NO(( <br />YES(I NOK <br />YES NO ( ) <br />YESV NO() <br />YESX No( ( <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA( ( YES() N <br />Is there knowledge or evidence of leakage from the tanks) andlor piping? of yes, please explain) YES (( NO <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name—C kos D Y 0 V E& —E)y Hauler Registration # <br />Address -643 0 AM T city —(OWLAfi- Zip—1 Z <br />Phone # ( SIO <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YESV NO( ] <br />b. Identify contractor performing decontamination: <br />Name _ .,�VL-yt Toju <br />Address—'/D Cl! 3 %7 EI - 5 city �� zip 6 <br />Phone No, -570 <br />C. Describe method to be used for decontamination: <br />d. Descl�itbe how rinsate material will be stored onsite pri r to manifesting offsite- _ <br />918Ltt0- WiLL Not be- <br />e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name V ,4j Hauler Registration # Z� <br />Address �® `L ^ City Q gyp__ <br />Phone No. ( 5/0 ,6-7. j- Q 33 L <br />Permitted Disposal Site /c-yi'11 { („o Cf i�/y ►�f} t Zeql /�/1 y %ZD • f��r O AM <br />EH 23 046 (Revised 08113199) Page 4 <br />