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1. Is there a contractor's questionnaire on file? NA [ ] YES jf] NO [ ] <br /> a) Is the questionnaire enclosed? YES ( ] NO [� <br /> b) Is the current certificate of worker's compensation insurance on file? YES [] NO [ ] <br /> C) Does contractor possess a 'Hazardous Substance Removal Actions Cert.'? NA [XJ 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 [J YES [ ] NO [] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES [ 1 NO [ ] <br /> No record f oproduct loss, however has failed a recent tank test <br /> 5. What will be the disposition of the tank(s)/piping? <br /> Pending analytical results from soil borings San Joaouin County <br /> will attempt to abandon in place. <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES( ] NO[ ] <br /> 7. Decontamination Procedures: N/A for soil assessment . <br /> a. Identity contractor performing decontamination <br /> Name <br /> Address City Zip <br /> Phone No.( <br /> b. Will tank(s) and piping be decontaminated? N/A YES [ ] NO [ ] <br /> C. Describe method used to clean tank(s) and/or piping (If not in conaactofs file): N/A <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: N/A <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. N/A <br /> a. Residual/Hazardous Waste Hauler <br /> Name <br /> Address <br /> City State Zip <br /> Phone No. Hauler Rebistmuion # <br /> Disposal Site <br /> Page 4 <br />