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1. (a) Is there a PAS-EiID contractor's questionnaire on Ole or enclosed? YES Q NO <br /> (b) <br /> [ ] <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES [rJ NO [ ] <br /> (c) Does the contractor possess a allmrdom Sobsfaoce Reaovd Cesti0cathm'? YES (,)/NO [ ] <br /> 2. Has i 'Bile Health tk Safety Pim'for this Job site been submitted? YES 14' NO [ ] <br /> 3. Hag app nt performing removal In the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAWYES[ ] NO"["] <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO yy <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler: <br /> Name10 C- PA Ynrr/`I �t/ire Hauler Registration #ZAL21L.? }/67� <br /> Address /2-33/ 22 City i cs ': Zip � � 9V <br /> Phone # ( D tr/l Y— 117 y`7/ <br /> 7. Decontamtna0oo Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES H NO [ ] <br /> b. Identify contractor performing decontaminations <br /> Namey (SWit ,l �1( <br /> Address zOi /klata bc(rr 7 L (lilt✓, city t✓1ade(c\ zip 36,3 <br /> Phone No. c)cj IG7Y (7 3 j O <br /> C. Describe method to be used <br /> /for t decontamination: <br /> /ilc�d /P u P ".I (til Thr re sx e�f SG[�'P <br /> �������• i l�G rum �r/c r�IGJ �'P rzv�C ��q�� <br /> d. /Describe how Ansate material will be stored onsite prior to manlfesting offslte: <br /> [ "� <br /> l/al fsC ss-t r�r'lL t..�`/ /_�o,yy�•P � ...:�a � � •� � o�•s<<' =:�/.7 <br /> e. Rinsate hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name PK!✓ //FSC'` "12G k F S Vie( V I C e Hauler Registration <br /> Address 7 Yl / 2� City e(2ltau zip <br /> Phone No. (AQP_) <br /> c <br /> Permitted Disposal Site ,✓bl� <br /> Page 4 <br />