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1. (a) Is Were a PE&EHD contractors questionnaire on file or enclosed? YES [ I NO [ I <br />(b) D the current certificate of workWo compensstlon Insurnam on mer rIA YES [ ] NO [ I <br />(e) Does the contractor, possess • Iffanwdous Sabsiaoee Rauval CeYifiotlon? YES [uI NO f I <br />2 Has ■ '8ite Halts & SUFIMV Pts• for this job site been submlued? YES [XI NO [ I <br />3. Has Wilmot performing removal in We City of Tracy obtained a Vrnding Rod Rwenvatku permit? <br />N/A [XI YES (j NO [ I If YM Pers9t # <br />I. Has the contractor obtained approval from We local fire department to perform tank tatting? NA(;f Mf I NO[ I <br />S. Is these knowledge or evidence of leakage from the lank(s) and/or plplW (II yes, please explain) YES [ I NO 11 <br />6. If tank residual erdsts, tdenM transporting hanrdoas waste haulm <br />Na. ENVIROPUR WEST Hardw Rmunition # 2591 <br />A =1 N- HIGHWAY 33 pt, PATTERSON Zip 95363 <br />Phone # r 8110 i 874 4444 <br />7. Deviation rmoccimreso <br />a. Will tank(s) and piping be decontamNuted prior to removal? YES p NO [ I <br />Q Identify amuwtor performing deeontaminstlosn <br />Name JAMES J. HOBLITZELL <br />Address Box 30331 CUT STOCKTON Zip 95213-0331 <br />Phone No.( 209 ) 943 7793 <br />e Describe method to be used for decontamination: <br />WATER, NON CHLORINATED CLEANER, HIGH PRESSURE STEAM <br />d Deserlbe bow rbteate material will fee arored mrNte prior to manl[ecHng offsite: <br />IL Rbwte Hauler and pesmitfed Trsatmmt, Storage & Disposal )radii?: <br />Hioier Name ENVIROPUR WEST Hauler Reglara lon # 2591 <br />Address 13331 N. HI ,HWAY 33 City PAT RSON Zip 9`363 <br />Phone No. ( 8UO ) 874 4444 <br />Permitted Disposal Site ENVIROPUR WEST <br />