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I . i <br />0 <br />1. Is there a coAtractor's questionnaire on tile? NA (t}/ YES (] NO [ ] <br />a) Is the questionnaire enclosed? YES [ j NO [ty <br />b) Is the current certificate of worker's compensation Insurance on Itle? YES (+"NO I I <br />C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA OYES [ I NO I j <br />2. Has a "Site Ilenith & Snrety Plnn" for this job site been submitted? YES R --,NO [ ] <br />t. Has applicant performing removal in the City of Tracy obtained a *Grading and Excavation Permit"? <br />N/A (� YFS I I NO [ ] If YES, Permit # — <br />J. 1lave.. tank(s) or piping pending removal leaked in the past? YES [ [ NO [ [ <br />5. What will be the disposition of the tanks)/piping? <br />� 1C• Ra �A � <br />"C NS La�rl� xr�u4 waw � tet% <br />6. fias the contractor obtained approval from the local fire department to perform tank cutting? NA14,4Y S[ I Not [ <br />7. 1 /Decontamination Procedures: <br />Identify contractor performing decontamination <br />Name <br />v Address K I 'rte t 1IIS City i Et ZIP �Q�__-- <br />Phone No (y_ -- <br />h. Will tank(s) and piping be decontaminated? r YES [ NO [ ] <br />c. Describe method used to clean tank(s) and/br Piping Of not in contractor's Me): <br />�l1 / Describe how rinsate material will be stoted on site dor to manifesting offsite: — <br />8. State Registered Hazardous Waste Haulers and Permitted UISPosel Facilities, <br />a. Residua ljlazardous Waste Hauler <br />Name'QAC— -- <br />Address — 11t r C — ---- <br />City AlLf. vk(V ,C A[) State l'A_ Zip --_—_-- <br />Phone No. jet _)0-3` ; — (�G HnulerReglslrntion # 0\5A <br />Page 4 <br />