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4� <br /> I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? ^ NO <br /> (b) Is the current certificate of worker's compensation insurance on file? 1�,r- YES [� , NO�(1 <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification"? YFS NO [ ] <br /> 2. Has a 'Site Health & Safety Plan'for this job site been submitted? YES V NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit" <br /> NIA [ ] M [ ] NO � If YES, Permit# `/ <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAS YES[ ] Nolk <br /> leakage5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ) NO T� <br /> 6. If tank residual etdsts, identify transporting hazardous waste hauler. <br /> cA-�o -yz:�v2B <br /> Name �rick5or I Tnc• Hauler Registration*_C 009yhlo39Z <br /> Address 2SS' Parr '�JkVa� city �it,-WtOJ zip <br /> Phone # ( S-10 1 Z 3 S— 13c13 <br /> Decontamination Promdurtt <br /> a. Will tank(s) and piping be decontaminated prior to removal? YFS NO [] <br /> b. Identify contractor performing decontamination: <br /> (Name 4f-o^5or, G✓\C7I V\ ar\ c . <br /> Address C.o60- " Qc� city Ran co Co rAgy'� zip q4S to <br /> Phone No.( �o ) V3 - ) (o4 (10 <br /> C. Describe method to be used for decontamination: <br /> Tr; p le R e <br /> d. Describe how rinsate material will be stored onsite prior to manifeStin offsite:. <br /> / <br /> 00MhycK ah� tr>tn�Doi <br /> P��TV Soyer TNC t'a/ U 110b5 <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> CA 1p- '1Lavag <br /> Hauler Name Er,ckSov\ TVI(_. nnHa�uler,Regis11tration #G4Doo946(0 <br /> Address 2S5 Pari 31yc1• city YC LnW ohA Zip l{ Q <br /> Phone No. ( sib ) 23 5—1I1- �C ' <br /> Permitted Disposal Site PRc. PG.I�TlSOI� Tv-. Pa-H-Vs-yn CA Gi 5-3 (03 <br /> Page 4 <br /> S -d NMR NVOE' ll 9661-SO-L <br />