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1. (a) Is there a PHS-Econtraetoes questionnaire on Ne or enclosed? YES [ ] NO <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES w/' NO I I <br /> (c) Does the contractor possess a 'Hwawdous Substance Removal Cerdncation'? YES [4'/NO [ I <br /> 2. Lias a 'Site Health h Safety Plan' for this job site been submitted? YES [yam NO [ ] <br /> 3. IIas applicant performing removaj in the City of Tracy obtained a %radtng wd Excavation Permit'? <br /> N/A [tel' YES [ l• Nq I l If YES, Permit # <br /> 4. Ilas the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ <o I l(/ <br /> 5. IS JltW knowl9dge or evidence of leakage from the tank/sl and/or piping? (If yes, please explain) YES [ ] NO (y <br /> 6. If tank residual exists, identify transporting hazardous waste haulers <br /> Name P R C . RC-m NF-P_ll '->V ry tck - Hauler Registration # 2 J f <br /> Address1�--3:11 �A r->• u .-'>7-�" clty t c G zlp 5,,5� 3 <br /> Phone # ( Z-02L'7Lfq- <br /> 7. Decontamination Procedures: <br /> a. WIII tank(s) and piping be decontaminated prior to removal? YES WINO [ ] <br /> I). Identify contractor performing decontaminations <br /> Name`3bA-Zez jhl L o S'Yecc-j-r'' m( A'. <br /> r <br /> Address L'_ C, U�13 kO KJ 5--,T,, City Sf c'I T0(1 n, Zip <br /> Phone No.( <br /> C. Describe method/o be ule decontaminatiout <br /> d. Describe how Ansate material will be tored j"Ite prior to manif5¢tln� oRslle: r <br /> Y'1.LSU d i L 7 _ 1, Jl wfA 1✓J /ods L� OOrc <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facilltys <br /> Ilauler Name i. V2-e(P[1 (ZU iC1"5 IIader Registration #7. <br /> S` <br /> Address AL)y City <br /> Phone No. <br /> Permitted Disposal Site r61=%A6E.2Z <br /> Page 4 <br />