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1. Is there a contractor's questionnaire on file? NA [ ] YES [q" NO [ <br /> a) Is the questionnaire enclosed? YES [ ] NO [4 <br /> b) Is the current certificate of worker's compensation insurance on file? YES [r]' NO [ <br /> C) Does contractor possess a 'Hazardous Substance Removal Actions Cert."? NA [ ] YES [W NO [ J <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [eNO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A ( K YES [ ] NO [ ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? YES [] NO [t <br /> 5. What will be the disposition of the tank(s)/piping? <br /> l) ISR0SrR&) F TANKS 4A14 Pli0iN' WILL Br: TO LC—V/N <br /> M ETAL-4 COR 9 ,4 , <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[q' ES[ ] NO[ J <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name _$E/YI co <br /> Address Y31 V, tt City IWO DeSzO Zip 9534-1 <br /> Phone No. 209 52 912 <br /> b. Will tank(s) and piping be decontaminated? YES [t- NO [ J <br /> C. Describe method used to clea tanlc(s) and/or piping (If not in contractor's file): Lo <br /> �tizS lMiD �P/.Vb Lliit t ,�3E 7TIlot F_ C) •c� /&� <br /> Tff iR > ivSE E CUiTi/ t-e .at CZ <br /> E IAlc es <br /> d. Describ how rinsate material will be stored on site prior to manifesting offsite: <br /> /3 ' <br /> 121W 64117"If /L rr <br /> E� <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Ha74rdous Waste Hauler <br /> Name G P D <br /> Address <br /> City /l9DoESD State r! Zip 5 Z <br /> Phone No. ( Z 09 L 5-7b— SSOD Hauler Registration # /!5B <br /> Page 4 <br />