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1. Is there a contractor's questionnaire on file? NA [ ] YES [ ] NO [ ] <br /> a) Is the questionnaire enclosed? YES [ ] NO [ ] <br /> b) Is the current certificate of worker's compensation insurance on file? YES kj NO [ J <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [4 NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES �,J NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [ J YES [ j NO [ J If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? YES [ ] NO 61 <br /> 5. What will be the disposition of the tank(s)/piping? <br /> 0.5; Gl/rift' it.�C <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ j YES[ j NO[ j <br /> �/fri-� Com;[� ��/1/o Tom,,,� c'✓m�-5 'mss <br /> 7. Decontamination Procedures: S(//N� T}�ivc /S' hitJcytyny <br /> a. Identify contractor performing decontamination <br /> Name t c <br /> Address City 15 /LHA)Zip 1 <br /> PhoneNo.(() �/oS'ZUUy <br /> b. Will tank(s) and piping be decontaminated? YES ] NO [ j <br /> C. Describe method used to clean tanks) and/or piping (If not in contractor's file): <br /> i �7y1_ <br /> cz <br /> i <br /> d. Describe homey rinsate material will be stored on site prior to manifesting offsite: <br /> /%iyS� L�/iLL hd, 5' 1�17 moi^//� S S 9�tGa..i 9i v�acS <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual azardous Waste Hauler <br /> Name <br /> AddressU <br /> City Stale zip l Lo/ <br /> Phone No. Z'�' ) l{l�s— Z��r�r1 Hauler Registration # 0-24-&5— <br /> Page <br /> -2.{feyPage 4 <br />