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• I. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YES [ ] NO <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [r]/O [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES We NO [ ] <br /> 2. Ilas a 'Site Health & Safety Plan' for this job site been submitted? YES V NO [ ] <br /> 3. IIas appjjanrifilt performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A YES [ ] NO [ ] If YES, Permit # <br /> 4. IIas the contractor obtained approval from the local fire department to perform tank cutting? NA[Y1"6 [ ] NO[ ]/ <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO lvl <br /> 6. If tank residualsxiissts, O !!ffa identify transporting hazardous waste hauler. <br /> NameG1=[ {�'I cS �Ci�'$ Hauler Registration #� <br /> Address /5'.33% AID., /w�l city��— zip <br /> —� <br /> Phone # ( ) gG 7 r7 77�/ <br /> • 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [,r- NO [ ] <br /> b. Identify contractor performing decontamination: / T <br /> Name STZC V— tl �t L�Yt Lt=_ -�'tictsl C r, pC.� <br /> Address O� t10. Jff'Lll� Vii, City—S. TL`l� Zip (t:-0Q <br /> Phone No.( 33 <br /> C. Describe method to be used for decontamination: <br /> FA nL gAoir— <br /> d. Describe howy�rinsate material will be stored onsite prior to manifesting ot site. <br /> I/CJT IIuaS At.[D � V1EPJ2C C— R l=/f.1ERl <br /> ( rtL 2u Y14� / S <br /> e. Rinsate IIaulerand permitted_Treatment, Storage & Disposal Facility: <br /> IIauler Name� Hauler Registration # <br /> Address 13 S,S'/ k/o r �� city LRMLLMSOAL zip_q 36,3 <br /> . Phone No. <br /> Permitted Disposal Site <br /> Page 4 <br />