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j • • <br />1. is there a contractoes questionnaire on file? NA (] YES NO <br />a) Is the questionuire enclosed? YES [ j NO <br />b) Is the current certificate or worker's compensation Insurance on file? YES (] NO <br />C) Does contractor possess a 'Hazardous Substance Removal Actions Cert.'? NA [ j YES [�]� NO <br />2 Has a 'Site Health & Safety Place' for this Job site been submitted? YES [r]/NO <br />3. Has applicant performing removal to the City of Tracy obtained a 'Gradlag and Excavation Permit'? <br />N/A [v / YES [ j NO [ j If YES, Permit I <br />4. Have tank(s) or piping pending removal leaked In the past? (If yea, lint tank #t) YES [I NO <br />5. What Will be the disposition of the tanks Ipin!? <br />DIS Posl77nn) DF TXf6 K Aivn G <br />G Has the contractor obtained approval from the local fire department to perform tank cutting? NA[q <br />7. Decontamination Procedures: <br />E! <br />b. <br />C <br />Identify contractor performing decontamination <br />Name <br />Addre: <br />Phone <br />NO[ <br />Will tank(s) and piping be decontaminated? <br />Describe method used to clean tank(s) and/or <br />in connacto�'s filet <br />-E PiNSF� u <br />YES le NO 1 <br />d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br />177z,7- <br />iPivsf7E /l%/f7E.Pi 9 L w/� i3� sza2� i2 s 6.4�co v k� <br />Gt?T �P/20U�0 wfTef/9 �PO�iP/47E Q�iy/ZI�e�S u 45TEy9 E�' <br />& State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br />a. Resldual/Hazardow Wase Hauler <br />Name -fCL/ED OLaZee 7 <br />Address .O. /93 <br />City state _ ZIP 953S2 <br />Phone No. Hasler Registration N <br />Disposal Site _ �Fiva<,2 y e2� cis y ��a C q - <br />Page 4 <br />