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i, (e) Is there • PUS-EIID contractor's questionnaire on Isle or enclosed? <br /> VESA NO [ 1 <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES NO [ ] <br /> (c) Does the contractor possess a Maardous Substance Remora) Certllfatlon'? YES NO 11 <br /> 2. Has a 'Site Health &safety Phm' for this Job site been submitted? YES NO [ 1 <br /> 3. fins applicant performing removal in the City of Tracy obtained a 'Grading and Isxcavatioa Permit? <br /> N/A I.] YES [ ] NO [ 1 H YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA71 YESI ] NO[ I <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explaln I 1 NO [r <br /> 6. H tank residual exists, Identify transporting hazardous waste hauler. <br /> Name <br /> Nor-Cal Waste Oil haulers Hauler Registration # CAD 982417255 <br /> Address P.O. Box 645 City Denair, CA Zip 95316 <br /> Phone # ( 209 1332-8710 <br /> 7. Deeoolamlmtion Procedures: <br /> it. Will tank(s) and piping be decontaminated prior to removal? YES 1$ NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name Jim Thorpe Oil, Inc./ DBA Rich-Mart Construction <br /> Address 351 N. Beckman Rd./ P.O. Box 357 City Led i,CA Zip 95241-0357 <br /> Phone No.( 209 1462-4581 JTO/RMC Ilaz Mat. hauler 11 2667 <br /> C. Describe method to be used for decontamination: <br /> On File at PIIS/EFID <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> The t will he removed by Jim Thorpe Oil Inc personel arid placed in <br /> durms- The drums will : rte : : , us to our yard at 807 Black Diamond <br /> Way, Lodi, CA to await pick up by a qualified collection company. EPA TICAL 000012884 <br /> e. Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Same as 11 6 Hauler Registration # <br /> Address City ZIP <br /> Phone No. ( ) <br /> Permitted Disposal Site Refineries Services Patterson CA or other approved facility. <br /> Page 4 <br />