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NA [ ] YES U NO [ ] <br /> 1. Is there a contractor's questionnaire on file? <br /> YES [ ] NO �] <br /> a) Is the questionnaire enclosed? <br /> b) Is the current certificate of worker's compensation insurance on file? YES NO <br /> [�] [ ] <br /> c) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [X} NO [ ] <br /> Z. Has a Site Health & Safety Plan" for this job site been submitted? <br /> YES NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA ff YES [ ] NO [ ] If YES, Permit # <br /> YES [ ] NO �] <br /> ( 4. Have tank(s) or piing pending removal leaked in te past? <br /> 5. What will be the disposition of the tank(s)/piping? Removal and di <br /> 7 <br /> om the local fire department to perform tank cutting?,NA �' <br /> YESNO[ <br /> 6.1 Has the contractor obtained approval fr ] <br /> t+1�rCk- Is lfi <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name dim Thorpe Oil Inc. d.b.a. Rich— Mart Construction <br /> Addres ec man Po. x. 7 City o 1 Zip <br /> Phone <br /> b. Will tank(s) and piping be decontaminated? <br /> YES [X] NO [ ] <br /> C. Describe method used to clean tank(s) and/or piping (if not in contractor's file): <br /> The tank (s) and associated pipirig will be triple rinsed on site by <br /> zc - ar ons eaning proce ure wl consis o ree <br /> rinses w� s earn or o wa er. ansae proce ure is on 1 e in your o ice. <br /> d, Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> Rins,21te. -igill he removed from-Lha-Lank (s) by. Jim 'horpe Oil Bich-Mart, <br /> eri <br /> i��11�P.t^ l�e� +r fiinn 1]C� PC �_u1 <br /> nnsr in ]s t <br /> The, rinsate wi11 he <br /> �, Wau. Lodi a. PA (Ai nOQ 0128$L� _ --- <br /> a r. 8n 7 Rl a rkD__iatnora � <br /> 8. State Registered Hazardous Waste Haulers and l•ermitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name Nor—Cal Oil Waste oil haulers <br /> Address Po Bx 645 State Zip <br /> City Dena i r Ca 95316 <br /> Phone No. ( 00 ) 332-8710 Hauler Registration #C AD 982417255 <br /> Page 4 <br />