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- <br /> 1. Is there a contractor's questionnaire on file? JUL () 1 I931 NA ( J YES NO ( [ <br /> _C' YES [ J NO ] <br /> a) Is the questionnaire enclosed? <br /> b) Is the current certificate of worker's compensation Insurance on file? YES JJ NO ( ] <br /> e) Does contractor possess a "Hazardous Substance Removal Actions Cert.'? NA ( ] YES (XJ NO ( j <br /> 2. Has a "Site lliealilt & Safety Pian" for this job site been submitted? YES NO + J <br /> a) USA underground utilities will be notified prior to excavation. <br /> 3. Has applicant perforating removal in the City of Tracy obtained a "Grading and ExcuvutiUrt Permit"? <br /> N/A it YES ( ] NO [ ( If YES, Permit # <br /> 4. Have tank($) or piping pending removal leaked in [lie past? Unknown <br /> YES 1 t Noll <br /> 5. What will be the disposition of the rank($)Ipiping7 e t ine tsa rl disposed of <br /> ril:e _� <br /> 6. Has the contractor obtained approval from the local fire department to perforin tank cutting? NA[ J YESIX] NO( j <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name Jim Thorpe ail f6c. d-b-a. Rich- Mart Construc:tiott <br /> Address ec man po. x. City <br /> Phone No.(�) - <br /> b. Will lank(s) and piping be decontaminated? YES JX] NO [ ] <br /> C. Describe method used to clean tank(s) and/orpiping (if not hi contractoes file): <br /> The tank (s) and associated piping will bQ triple rijised on site by <br /> . is _ r ons UT— <br /> ean�ng proce ure wr consrs o ree <br /> rinses w1 s eam or a wa er. rasa e proce ure rs on r e in your o ice. <br /> d, Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> ya ill! Thorpe Oil / hir-li-MIt� <br /> C�t�S�n" rt inn Ha7arrinu� agtP la'11R! lla►�laC 3 tits tiQCL�l11L(lil�ry- -- <br /> a <br /> id <br /> toy ak ���i-�, �� . <br /> ��� V 3 <br /> g, Stale Registered azardous Waste Haulers and Fermitle� Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler ' ��t (o 3 <br /> Name o -C a to oil yule 9 <br /> Address Q Stale ip C f W <br /> City Dena r Ca 3 b <br /> Phone No. 8LO ) 332-8710 Rattier ReLisUutlutt #CAD 982417255 <br /> Page 4 <br />