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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES I 1 NO V( <br /> (b) Is the current certificate of worker's compensation insurance on file? YES I✓I NO [ 1 <br /> (c) Does the contractor possess a 'Barardoas Substance RCNKV"d cWti6catloun YES t'7 NO [ 1 <br /> 2. Has a 'Sitz Elea" d. Satdy Plan' for this job site been submitted? YES ( NO [ l <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Gradlug and Excavation Permit"! <br /> N/A YES [ 1 NO [ 1 II YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ 1 YES[ NO[ 1 <br /> 5. Is there knowledge or evidence of leakage ffrom the tank(s) and/or piping? (If yes, please explain) YES [ 1 NO [vr� <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name G rs Ell rY lr-C_V, Hauler Segistmtioa # <br /> Address J 3_53 _ CitygZj]k&6 A) Zig 6 <br /> Phone # Ecl <br /> _ <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES Nf NO I ] <br /> b. Identify contractor performing decontamination: <br /> Name �c�-4 _"S►cr I4 C-4F- <br /> Address 20 M J>. U ,� ia� !� City �a A� Zip -- <br /> Phone No.( Z o4 ? ck 6cA_g 3 3 7 <br /> C. Dtribe method to be used for ntamination: <br /> 0 i <br /> d. DMcribe how rinsatejuaterial will be stored on prior manifesting offslt+c: , <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name (�e I # <br /> Address/13S / Al, A/ � City x•� Zip <br /> Phone No. ( 0 D 2 —) —6 tfz, <br /> Permitted Disposal Site <br /> Page 4 <br />