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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES rl NO ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES ((r NO [ ] <br /> (c) Does the contractor possess a 'Hamrdous Substance Removal Certification" YES E-f NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES Pe NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit-' <br /> N/A ftp( YES [ ] NO ( ] If YES, Permit # <br /> 4. Has the rnpO opjatn gppro�al�op the local Gre epartment to perfotrp tanLrcutting? N V s YES[ ] NO[ ] <br /> N �{(_ oYl TT`�w i 1 l , -0. V,\." o1 t t> C^ prc vc P vs`r <br /> S. Is there knowli ridence, leakage f m the tank(s) and/or pining? (If yes, pleanse explain) YES [J NO [ ] <br /> � J Q' YYc '17 c <br /> OAK L, (0-6PCRA <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name �i!�ICeG L 17(� Hauler Registration # <br /> Address �L S pax-, ':�IkvC'0 City GN m zip Cr <br /> Phone # C51 ) -�J 1;- 39 3 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES/ NO ( ] <br /> b. Identify contractor performing decontamination: <br /> 1 <br /> Name AmICC 11 <br /> Address v)( ( �iX.C/h"Ar l 1 City ` C (7(e zip E550 <br /> Phone No.( <br /> C. Do�be method to be used for decontamy'�atioq: /� / <br /> 9IJS� () rte n� �bw[6 uJ/ I tt�✓ �etvy! X UQhuUi i f �rict <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> \).j, Il l 1 ri Lt C�C <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: p/�j�� <br /> Hauler Name �r� �'�-' Hauler Registration # l <br /> Address �S Yn� 1 �City , q Vzip 14 cf/�b b 1 <br /> Phone No. I O 2- /3 5 `- <br /> Permitted Disposal Site <br /> Page 4 <br />