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1. (a) Is there a PHS- EEID contractor's questionnaire on rile or enclosed? YES f -J' NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on rile? YES kw4 NO [ ] <br />(c) Does the contractor possess a 'Hazardous Substance Removal Catirxstion'? YFS * NO [ ] <br />?. Has a 'Site Health & Safety Plan' for this job site been submitted? YES b� NO[ ] <br />3. Has,dg,,plicant performing removal in the City of Tracy obtained a 'Grading and Flu a on Permit" <br />N/A�] YFS [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local rice department to perform tank cutting? NA"J ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO -",- <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name 'C V 12 °� VIT-K) U (— Hanky Registration # e!�D/ 9 <br />Address City R t4 A— a Zip <br />Phone#(Sly <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 NAA <br />AA <br />r <br />Address City Zip <br />Phone No.( ) <br />C. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting onsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Hauler Registration # <br />Phone No. <br />Permitted Disposal <br />Page 4 <br />City <br />Zip <br />