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Is there a PIIS•EIiD contractor's questionnaire on file or enclosed? YES I ] NO w �l <br /> (b) Is the current certificate or worker's compensation insurance on file? YES VNO"*04I ] <br /> (c) Does the contractor possess a 'iLa�arrdosui t3al�lance Re "I Certification"? YES U4 NO I 1 <br /> 14'-' <br /> NO <br /> Iia@ a 'Site Health &Safely Place' for this job site been submitted? YES Irl' NO I ] <br /> 3. Ilan appal ul performing removal in tine City or Tracy obtained a 'Grading and Eccarration Permit'? <br /> NIA YES I ] NO I ] if YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[r.]' M'I I NO[ I <br /> 5. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (Ir yes, please explain) YES [ ] NO <br /> A(0 K5 <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler. <br /> Name ((� 'L R�r - Hauler Reglstntlon # <br /> AddressCity <br /> Phone # ( <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES NO [ 1 <br /> b. Identify contractor performing decontaminatloni <br /> Nama_S7t�c�ro PV��Via,.. :Q <br /> Address !:Q . , C� City AJ ZIP ?2;720 <br /> Phone No.(,-. <br /> C. Describe meth to be used For decontamla n: <br /> KCALSF <br /> i <br /> d. D crlbe how rin�te matial w l be stored or ate prior to manlfe@ting onsite: <br /> e. lUnsate Ila uler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name C 7 r flamer Registration #Am- <br /> Addressa—svLe City itJ Zip <br /> Phone No. �O c/Z <br /> Permitted Disposal Site i{�r. ! � �tfe2ll1 <br /> Page 4 <br />