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10/17/2000 09:00 20946K 1 FIFTH FLOOR PACE 04 <br /> 1. (a) 4c there a PKSMM Contractor'a sad subcmtmttaes gnestloaualrq OR f11e or enclosed? YES[] No bQ <br /> (b) Is the mtrreat eertlficare of worker's Compeasatton htsersaee ea 60? YES)([ Na(] <br /> (o) Does the contractor possess a"Hasardoua Sabstaum Romagsi Cerancatlm"? YB i�] moll <br /> (d) Has everyone on site,Inclndisg cranerbackhos operator,beeu Certified <br /> to work on hazardous waste site in accordance with CCA Title 8? YES k] N0 i} <br /> 2. Has a•Hite Health lb Safety Plum for this job site been submitted? <br /> YES t4 Noll <br /> 3. Has applicant performing removan to the City of Tracy obtained a"6Yidlttg and Rota atloa Parmu-? <br /> N'Aj� YES(] NO[I ffYES, Permitf <br /> 4. Has tfe contractor obtained approval from the ictal fire department to perform tank eaUhV NA[)YHSk)No[[ <br /> S. Is More kltowledge or evidence of leakage from the Wk(s)andlor plping? (If yes,please ettplaht)YSS[t No K <br /> 8. If tank residual exists,ldenttfy transporting basardous waste hauler. <br /> Name SaNee Repsbaior/ <br /> Address N 9p <br /> Phone/( } <br /> 7. Deomtamlaad"Procedures T vk S '•A k u 7 A �'�i ivy's gP��W rL%PLti CZ%rr C c <br /> Qy w C Kin PLEW&C. SET; T%_:w, v_c>swac OM'r&wkS <br /> a. Will tank(s)and p11in8 be deconWalnated prior to removal? TOM N91) <br /> b. Identify contractor performing decontammatlem ALR @ ko CONS P l Vz i ii Q li `1 H,v Y S i c K.1J GI-0 <br /> Name Otu Tr.vh P G�oSv til% Pi�IZ M •C' <br /> Address- _ City ZIP <br /> Phone Nc., A'1 <br /> C. Describeu <br /> method to he e"Q Mir decoutaulhiatiott: 1 V / <br /> d. nnscribe how Ansate material will be stored ozone prior to manifesting offsite: <br /> e. Wnsate Hauler and peas*Mdabsent.Storage&Disposal FadRry: <br /> Hauler Name -.t r� Healer Registration/ <br /> Address Ctty 3Ip <br /> PhuneNo.( <br /> Permitted Disposal Site <br /> YHY3046 (Revised 0811 US) Page <br />