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0 0 <br /> J. <br /> is there a contractor's questionnaire on file? NA ( j YR-S ( ] NOK <br /> a) Is the questlonnalre enclosed? YES ( ] NO X <br /> b) Is the current certificate of worker's compensation Insurance on file? YES ( ] NO J f <br /> C) Does contractor possess a `Hazardous Substance Removal Actions Cert."? NA ( j YES )>Q NO <br /> 2. Has a 'Site Ilealth & Safety Plan' for this Job site been submitted? YES I ] NO PQ <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permlt'7 <br /> N/A(X YES [ ] NO ( j If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked In the past? (If yes, list tank #) YES O NO ( J <br /> 5. WI at will be the dispositlo of tie tank(s)/plping? 1 <br /> 2�U n 1 lj S It,— C <br /> G. Has Ute contractor obtained approval from the local fire department to perform tank cutting? NA,K YES( I NOI <br /> 7. Decontamination Procedures: <br /> TA%A IS t3 NJ pf ID's- 41.r <br /> s/ s I �+1` . 1 ] c exj <br /> 'f j'I /-I ep +-' q4\ <br /> a. <br /> �U'✓ r� lJ' F'C'�Y�lr7l <br /> a. Identify contractor performing decontamination <br /> Name TAyq k QXC.AVf H <br /> Address -z��t 1 n. r City 2 Zip <br /> Phone No.(Pof) [ <br /> b. Will tank(s) and piping be decontaminated? YES j7(! NO J J <br /> C. Describe method used to clean tank(s) and/or piping (if not in contractor's file): <br /> o w <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> g. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Rcs[it I/H zerdous Waste Hauler <br /> Address Li2 . <br /> City , ;fir, F t A ltiL ;,u State < f�- Zip <br /> Phone No. (;// S ) ' ' illauler Registration # ' <br /> Disposal Site ii vt 1' ;"1I., j t <br /> Page 4 <br />