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NOW .. <br /> I. (a) Is there a PHS-EBD contractor's questionnaire on rile or enclosed? YES ]' NO [ ] <br /> (b) Is the current cerimcnte of worker's compensation insurance on file? YES r-<TY' NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES NO [ ] <br /> Z. <br /> ( D Has a 'Site Health & Safety Plan' for this job site been submitted? 1=V �� lly& YES , NO [ ] <br /> `• 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit^. <br /> N/A>( YES ( ] NO ( ] If YES, Permit # <br /> Has the contractor obtained approval from the local fire department to per?�0r t� 'Elft c ccuutiti NA[ ] 1E ANO( ] <br /> 5. Is there knowledge or esidence of leakage from the tank(s) and/or piping? (If yes, please explain) 1D ( ] NO X <br /> 6. If tank residual <br /> exists,� " "identify transporting hazardous waste hauler. <br /> Name lc�cwlrs rill✓/9rn/{'yl Q t/'f }L Hauler Registration #—C-1:27 <br /> — Address 1S! C -5a-,VTH AYVEZ S/9<72) Zip 9564/ <br /> Phone # ( A 1 —3—Zl —Z5`70 <br /> 7. Decontamination Procedures: r ' <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES 6CI NO [ ] <br /> b. Identify contracor performing decontamination: <br /> Name A L11�72 e\l�'�l(9n(A�_ 1•E lel uLOC7 ca <br /> Address qcS- /4CZM� !n Bt.,\lp City { 4ML T741 --ZZip (7q— � <br /> Phone No.( 51 0 3'I Z— 9"/ OCD <br /> C. Describe method to be used for decontamination: <br /> TR-10 lE F-1 ov S(ty Lr <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> feu!-iAM 64,tT4:5-TLs/t C /5 1154Cc ktiQ7 MzZo DIVIe-E2 <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> _ Hauler Name /^//=P 1k4�) Hauler Registration # <br /> Address City Zip <br /> — Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />