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VW <br /> 1. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YES)Q NO [ 1 <br /> (b) Is the current certificate of worker's compensation Insurance on Hie? YES 1'V NO [ J <br /> (c) Does the contractor possess a 'hazardous Substance Reaaoval Certification"? YES NO ( [ <br /> 2. Iles a 'Site llalth A Safely Plan' for tills Job site been submitted? YES r( NO [ J <br /> 3. Iles applicant performing removal In the City of Tracy obtained a *Grading and Excavation Permit'? <br /> N/A I I YES I I NO ( I If YES, Permit M <br /> 4. Iles the contractor obtained approval from the local fire department to perform tank culling? NA(d YES( J NO[ 1 <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ 1 NO Ill <br /> 6. If lank residual exists, Identify transporting hazardous waste haulen <br /> Name Nor-Cal Waste Oil maulers Wulcr RegistraUoo A CAN 902417255 <br /> Address 11.0. faux 645Clty Denair, CA Zip 95316 <br /> Phone Y ( 209 ) 332-8110 <br /> 7. DcconlaminaUon Procedoress <br /> a. Will lank(s) slid piping be deconlamin ted prior to removal? YES NO [ 1 <br /> It. Identify contactor performing decontaminations <br /> Name Jim '1'morpe Oil , Inc./ DNA liich-Mart Construction <br /> Address 351 N. Declanan Rd./ P.O. Dox 357 Clly L(xli ,CA Zip 95241-0357 <br /> Phone No.( 209 ) 462-4501 .1'1'O/HMC Ilaz Mat. hauler d 2667 <br /> C. Describe methodto be usid for decontamination: <br /> On File at 1'113/1-:111) <br /> d. Describe how rinsate material will be stored onslle prior to manifesting offsite <br /> 111P. vmltsealjWWII be i.eo.. yed by Jim '1'Lnrnn Oil 111C Pel•sonel acid Placed in <br /> thin.. The (Iijilis will be i .,aigii, r ed by us to our yard at 80'7 Black Diamond <br /> Way, Lodi, CA to await pick up by a qualified collection company. GPA VAL 000012004 <br /> e. Rhnsete Ilauler and permitted Treatment, Storage h Disposal Facility: <br /> Ilauler Name Same as If 6 Ilsolcr Registration <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Dlsposnl She Refineries Services Patterson CA or other approved facility. <br /> Page 4 <br />