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g8I1^c,/'L@o6 14:53 2094653433 <br /> EHL! PAGE 05 � <br /> 1. (a) Is there a EHD contractor's and cubcuntractueS question snaire on Elle or enclosed.? �ES 1 NO[] <br /> (b) is the current certificate of worker's compensation insurance on.file? YES ] N�(] <br /> (c) Does the contractor possess a"Hazarde us Substance Removal Certification;"? YI:S)g NO I] <br /> (d) Has ever one on site,including crane/uackltoe operator,been certified to work-.on <br /> (e) hazardous waste site in accordance with CCR Title 8? YES{� '140[] <br /> ?. Has a"Site Health&Safety V1 an"for tris]oto site been submitted? YES { NO [] <br /> 1 Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Peramit"? <br /> N/AX YES[] No C I If YI$, Permit# <br /> 4. Has the contractor obtauned approval from the local fire department to perform tannic catling?NA YE*Nth[j <br /> 5. is there knowledge or evidence of leakage from the tank(s)a'nd/or pipixtg? (If yes,please explain)YES J] NDA <br /> 6_ If tank residual exists,identify transporting hazardous waste hauler: <br /> Name—A> Hauler Registration#.Am 66/S <br /> Address 4366 6Czr QJ �l/e. _City `— Tip ?Ofd o <br /> 7. ]Deeontannirtation Procedures: <br /> a. Will tank(s)and piping be decontaminated pricr to rernDval? YES I] NO I] <br /> b_ Identify contractor pexfoxming decontamination: <br /> Name J a <br /> Address�I 3 'F WS+�M c& ) Dt2 t LR— _city -? ��_:Ztp <br /> Phone No.( Us ) C),-G Z <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite priw to W.W-:ifesting offsite: <br /> e. l insate Fauler and permitted Treatment,Storage&Disposal Fa,,.i ity: <br /> Haute.Name_ 5 G"vt (ZOVA Hauler Re gistratiarn# � <br /> Andress r �� f_�—N '; ty alp 1yGO <br /> Phone No, S' 0 <br /> Permitted Disposal Site <br /> EH 23 046 (Revised fii9.106) 4 <br />