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12!10/2002 09:39 2094603433 FIFTH FLOOR PAGE 08 <br /> 1 <br /> 1. (a) Is there a FSS-1391)contractor's and subcontractor's questionnaire an fue or enclosed? MK N©I 1 <br /> (b) is the current certificate of worker's compensadon Insurance on file? YES K Noll <br /> (c) Dogs Elle contractor possess a"HaaardouB Substuce Removal Certification"? YES K Noll <br /> (d) Has everyone onstta,lgcladingcranefbackhoeoperator,been,ccrdBed <br /> to work an hazardous waste glte In accordance with CCR Title 87 YPsS� Koji <br /> 2. Has g"Sita Health&Safety?1W for this job site been submitted? YBSPI", NO I I <br /> 3_ Has applicant perfornOng removal fn the City of Tracy obtalned a" radtng and Euxvadoti!°erir lt`? <br /> puA&t_ YES)j NO[] It Y85,76VMdt 0 <br /> 4. Has the coatmetor obtained approval from the local tiro department to perform tank cutting?NAKn"Sf I NO[I <br /> 5. Is there knowledge or evidence of loa]tage from the tanks)andlor piping? (If Yes,please explain)YES[I NO <br /> • y <br /> 6. If tamp residual etl'scs11,idendly transporting bmardous't+aaste bmuler. <br /> V <br /> Name t'1►,,e 5 l Eauler Reglstradws# Cf't C3 $ 6!5 <br /> Address �d� P4t �} - GitSt_P n C l a zip_4y <br /> Phone Pl72 q ' <br /> 7. Decontami11,11 n Vraeedurea: <br /> a ww taWs)and piping IEE decontaziWted,prior to removal? YSSJQ NO I 1 <br /> h. Identify Contractor perforrobe decontamination: <br /> Name <br /> Address lQ CQR -city &0tLlQ Alp <br /> Pbone No.( *W? ?t#`) <br /> C- Describe method to be used for deeontam1nation: <br /> hpr t s T <br /> tl- Describe how rinsate material will be starcd unslte prior to Manifesting 0113110: <br /> PP kaw <br /> e_ Rtttsate Hauler and parmltted Treatment,Storage h Dispagal Faculty; <br /> Hauler Name V U t, Ranier�Iagietrstfort CA Q 3 65 22')2 <br /> Address u I P( �QIL-tip R D City <br /> PhoneNo.( ')07 <br /> Permltted Disposal We <br /> fSH M 095 (Revised 118113!99) Page 4 <br /> 12/1.0/02 TUI; 09: 43 [TX/RX NO 87091 ZOOS <br />