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1. (a) Is there a PAS-EIID contractor's questionnaire on file or enclosed? YES J* NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on rile? YESNO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES NO [ ] <br /> 2. IIas a 'Site Health & Safety Plan' for this Job site been submitted? YES NO [ ] <br /> 3. Has�ap{plicant performing removal in the City of Tracy obtained a 'Grading and Eza9vation Permit'? <br /> N/A YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAKYES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YFS E ] NO <br /> A1O <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name 4A Hauler Registration # <br /> Address CityZip <br /> Phone # ( ) <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 /> Name PJA <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> ✓`y A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> .4A- <br /> e. Rinsate Hauler-and permi/tted_Treatment,.Storage & Disposal Facility: <br /> Hauler Name 1tHauler Registration # <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />