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1. (a) Is' <br />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 Certification"? <br />(d) Has everyone on site, Including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? <br />3_ Has applicant performing re oval In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA I ] YES ( ] NO HIf YES, Permit # <br />YES[] NO[] <br />YES[] No <br />YES NO ( ) <br />YES NO [ ] <br />YES wlio I ] <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO[ <br />5. Is there lrnowiedge or evidence of leakage from the tank(s) andlor piping? (It yes, please explain) YES [ ] NO <br />G. If tank residual exists, identify transporting hazardous waste hauler: <br />Name Ace Z Hauler Registration #__ 019 <br />__�� <br />Address City/C"IM0 Zip ! J _ _ <br />Phone # / 3S _ /.3 23 <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 476-7 <br />Address1,Y City l zip 0% <br />Phone No.( , / o )_ _ S- .12 3 <br />c. Describe method to be used for decontamination: <br />7. I P S <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 /C " ZIP <br />Phone No. ( <br />Permitted Disposal Site TO,-ilc Lr� IqZ 70 <br />EH 23 046 (Revised 08113199) <br />Page 4 <br />90 39Vd 600-ld HidId 66V689b60Z Z0:60 000Z/LT/90 <br />