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.Nt <br /> n 11ry <br /> ,rR Is there a PIIS-EIID contractor's quesllonnnirc on file or enclosed? YE.4-W( NO <br /> `* '(b) Is the current certificate of worker's compensation Insurance on rile? YES W NO ( j <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YLSsW NO [ ] <br />'.. IIas a 'Site Health & Safety Plan" for this Job site been submitted? YES $.4 NO I 1 <br /> 1. <br /> this applicant performing removal In the City of Tracy obtained a 'Cradlug and Iretivation Permit'? <br /> N/A YES [ J NO ( ] If YES, Perndt # <br /> 1. IIas the contractor obtnlned approval from the local fire department to perform tank cutting? NAr YES[ ] NO[ ) r <br /> 3. Is there knowledge or evidence of leakage from the tonk(s) and/or piping? (If yes, please explain) YES [ ] NO _ <br /> If tank residual exists, Identify trunsporting hazardons waste hauler: <br /> Name._ �)/L C / ,�/Ale—lz? f ES �2 llauler Registration # 2-5— <br /> Address Cityz� .cow/ zip S f�G <br /> Phone # ( y 9 )_ �j Z - (, ] y2 <br /> 7. DecontaminatlonProcedures: <br /> a. VIII tnnk(s) and piping be decontatnlunted prior to removal? YES(* NO ( ] <br /> b. Identify contractor perforndng decontamination: 7 <br /> Name ST-OCl4�7c)_-/ iZyir - ST/-iT/dA) �GZJ/ � CD /<iC, f <br /> Address <br /> City zip <br /> Phone No.( -209 F T 3 3 <br /> C. Describe method to be used for decontamination: , <br /> 7� r Z_ <br /> it. Describe how Ansate material will be stored onsite prior to manifesting oRslte: <br /> d o r 71zu i `s i c '25 Ov <br /> e. Massie Ifauler and permitted Treatment, Storage & Disposal Enellity: <br /> IlaulerNamL ill Giri� >'// ✓, hauler Registration # <br /> Address ? .T3 (7/ /t�, wy City 7.tp /Sr3Co <br /> Q �-- <br /> Phone No. oc7 Z. - <br /> Permitted Disposal Site <br /> Page 4 <br />