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2 <br />3. <br />4. <br />5. <br />6. <br />7. <br />0 0 <br />Is there a contractor's questionnaire on file? NA [ ] YES NO [ ] <br />a) is the questionnaire enclosed? YES [ J NO [tr <br />b) Is the current certificate of worker's compensation insurance on file? YFS [ ] NO [ ] <br />C) Does contractor possess a 'Hazardous Substance Removal Actions Cert.'? NA [ J YES NO [ ] <br />Has a 'Site Health & Safety Plan' for this job site been submitted? YES M'NO [ ] <br />Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br />N/A [� YES [ J NO [ ] If YES, Permit # <br />Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES[ J NO [i}� <br />What will be the disposition of the tank(s)/piping? <br />1., --1 ..� -,-r/canin iO/d/niL <br />Has the contractor obtained approval from the local fire department to perform Egnit cutt g? Nf((J YES[ ] NO[ ] <br />CU t1\,n55(Jerior+a Vn e" <br />Decontamination Procedures: P -er MS i 1 o, <br />a. Identify contractor performing decontamination <br />Name <br />Addre. <br />Phone <br />b. Will tank(s) and piping be decontaminated? <br />C. Describe method used to clean tank(s) and/or <br />d. Describe how rinsate material will be stored on site <br />i - <br />(If not in contractor's file): <br />to manifesting offsite: <br />S,nizr� /2 S <br />8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br />a. Residual/Hazardous Waste Hauler <br />Name lr:LL/ED �L� <br />Address l'✓oa lg3 <br />City State r Zip <br />Phone No. Hauler Registration # <br />Disposal Site 'y=422f r ;, C'q- <br />Page 4 <br />YES [" 1 NO [ ] <br />e <br />R- <br />M <br />