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`„ a./ <br /> 1. Is there a contractor's questionnaire on file? NA K YES [ ] NO (� <br /> a) Is the questionnaire enclosed? YES [ ] NO [ ] <br /> b) Is the current certificate of worker's compensation insurance on file? YES [ j NO [ j <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA]iQ YES [ ] NO [ J <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES ( J NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A Dq YES [ ] NO [ ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES ( J NO <br /> 5. What will be the disposition of/� / �7 <br /> the tank(s)/piping? r� <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NAK YES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing deco Lamination <br /> Name HUH SEAIrr c ey <br /> Address .Z 2Q /jjc+a �., City iuu�e� Zip 9 /07 <br /> 7 <br /> Phone No.( <br /> b. Will tank(s) and piping be decontaminated? YES [ j NO [] <br /> C. Describe method used to clean tank(s) and/or piping (If not in contractor's file): <br /> d. Describe how rinsate material will be stored on site prior- to manifesting offsite: <br /> P&c n <br /> C ZZ <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/H rdo Waste Hauler <br /> u <br /> Name /{ <br /> Address 2 <br /> City State Zip 9' / O <br /> Phone No. /S S�3- �{83S Hauler Registration # 2 DOvrS� <br /> Disposal Site <br /> Page 4 <br />