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9 <br />1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[ 0 [ j <br />(b) Is the current certificate of worker's compensation insurance on file? YES [,,�/NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [,j/1G0 [ ] <br />(d) Has everyone on site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES 14'NO ( ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES ('NO [] <br />3. Hasacant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA YES [ j NO[] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAM frS[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO� <br />6. If tank residual exists, Identify transporting hazardous waste hauler. <br />Name \/A - % i!iq v e g g rill Lg&auler Registration # 3 — <br />� <br />Address city L�y tl t Zip clS _ IS' <br />Phone # c cC '7 3 q6 zfS--- <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES IJ -40 [ ] <br />b. Identify contractor performing decontamination: <br />Name -.� ,<4- -fc <br />`'Address Ct756> ; -i _ rL t;4'i �� T . City Sr-.� /J zip S Z t <br />Phone No ( <br />C. Describe method to be used <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />M <br />Al <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name t «, ==� - A' ` 'ki tt �I r1i X r �`4 N =, r re . Hauler Registration # <br />Address C ��' k �`f City SDE -i -Ft -1 `Zip <br />,, <br />r� -3 � _7� <br />Phone No. (�' ) 6 _// � <br />Permitted Disposal Sitehte7c i �2t L, �.2�r'tc 6 i - <br />c + <br />F / , <br />EH 23 046 (Revised 10/19/98) Page 4 G.A C.7:- 6`t`q z4Fj Z 170 3 <br />