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1 <br /> 1. (a) Is there a PSS-EHD contractor's questionnaire on rile or enclosed? YES 11' NO I I <br /> ' (b) Is the current certificate of worker's compensation insurance on rile? YES`[ NO I l <br /> (c) Does the contractor possess a "IIzzardoas Substance Remand Certification"? YEAS NO C 3 <br /> 2. Has a 'Site Eleaitlb do Safcq Pied for this job site been submitted? NO [ l <br /> ' 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'! <br /> NIA jr YES [ ] NO [ ] If YES, Perm It# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[4 X6[ l NOI ] <br /> ' 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ I NO [�]' <br /> 1 <br /> 6. If to residual exists, identify transporting hazardous waste hauler: <br /> Name ?*r,`r o�1 �€ ; '� �f�L'j , Hauler Registration # x /�'0J`f`j <br /> Address I>�� 3.� - .1 City � e 5 c'.j Zip �j <br /> Phone # +`�� O 7 <br /> ' 7. tlan Procedures: <br /> a. Wil1 tank(s) and piping be decontaminated prior to removal? YES [ NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name A A)z - �® <br /> 1 Address City J��'f S�c� zip . 37 i <br /> Phone No.( cM <br /> c. Describe method to be used for degonta anon- <br /> / fJ <br /> /1`%?'z P//J---,*_ --, <br /> O)C A <br /> Describehaw :luau a material will be stored onsite prior to manifesting offsite: <br /> 1 <br /> e. Rinsate hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name T 746'7Tt" ._Sc, T";. Thaler Registration # XL9 6 7�k <br /> Address 13- 33 city47,�-*j zip '� <br /> Phone No. ( 4 OO ",/ <br /> VW <br /> 14) <br /> n/L <br /> Permitted Disposal Site ; �� <br /> ' Page 4 <br />