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1. Is there a contractor's questionnaire on file? NA pl YES [] NO [] <br /> a) Is the questionnaire enclosed? _ p YES [ ] NO <br /> (B ! _ [ ] <br /> be s�t�in�i[u� re& <br /> b) Is the current certificate of worker's compensation insurance on file? YES j/� NO [] <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA YES [ ] NO [ ] <br /> Has a "Site Health &1 Safe Plan" for thi; 'ob site een submitt ? 1 /� ! YES WNO <br /> �aSfo✓Safety fD 5trk. S, SA1 iC S'A�t7� / ��•/- [ ] <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? YES [] NO <br /> 5. What will be the disposition of the tank(s)/piping? <br /> /d4- OF W4C /N ✓UW &ZgF5 <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA�,YES[ ] NO[ ] <br /> 7. Decontamination Procedures: N/4 <br /> a. Identify contractor performing decontamination <br /> Name <br /> Address City Zip <br /> Phone No.( ) <br /> b. Will tank(s) and piping be decontaminated? YES [ ] NO [] <br /> C. Describe method used to clean tank(s) and/or piping pf not in contractor's file): <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. ^//A <br /> a. Residual/Hazardous Waste Hauler <br /> Name <br /> Address <br /> City State Zip <br /> Phone No. ( ) Hauler Registration # <br /> Page 4 <br />