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v r <br /> 1. Is there a contractor's questionnaire on file? NA [ ] YES P4,_ NO [ J <br /> a) Is the questionnaire enclosed? YES [ ] NO Q� <br /> b) Is the current certificate of worker's compensation insurance on file? YES4K NO [ ] <br /> C) Does contractor possess a 'Hazardous Substance Removal Actions Cert'? NA [ ] YES, , NO ( ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? 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 /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES [] NOX <br /> 5. What willbethe disposition of the tank(s)/1Diping? I <br /> -I n kP rFM1h JPJ c] dls fXstpq 6, <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA�(YES[ ] NO[ ] <br /> 7. Decontamination Procedures: II <br /> a. Identify contractor performing decontamination�fct Rtct,,.vrn�) <br /> Name <br /> Address City Zip 0 <br /> Phone No.( ) X,59-11K3 <br /> b. Will tank(s) and piping be decontaminated? ,Vp Attu( at kG1uIQov1 YES [ J NO� <br /> C4 Describe method used to clean tans) and/or pipinh �ao.td contractor's file): <br /> lui/I A0./ kly <br /> � <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> AJ14Ac <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name t <br /> Address SSS arr <br /> City AlckmcNd State Zip 0 <br /> Phone No. ( Hauler Registration # 01 c/ <br /> Disposal Site 4�r++r- sdn� nCi it rnnn4 <br /> Page 4 <br />