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1. (a) is there it PIIS-UIID cootltnchtr's tpneslitntnaire on file or enclotsed7 YUS 1X1 NO 1 1 <br /> (b) Is the cottent cettilicnte of wottker's.cotnpemallon inrsorance on tile? YUS 171] NO I I ! <br /> I ; <br /> (c) Dees the conhacidrr possess a "Ilaaa►dtnts SuM,viance Removal Cerlilicalhm7" YUS 17q NO 1 1 <br /> 2. Ihas a "Site Ilealth&Safety flan" for this jolt site been sadtnnitteW YUS 171 NO I i <br /> 3, sins#1141cam petfrtrntbrg terniml in lite City of Tracy olNnined a "(irnding and Uxcavadon hermit"7 <br /> N/A IX 1 YUS I I NO I I If Y13.S. Pettish t1 <br /> 4. Ilas cmrtraclor ahtairted apprrwai Bonn the local lite departrtrerN to perfinro lank aNting7 NA 1X1 YHS I I NV 1 I ; <br /> S. Is Ilrete knowledge or evidence of leakage front Ilse lank(m)anol/or piping?(If yes, please explain) YUS NON <br /> 74 <br /> ft. If tank teskhral exists. Idendry ltaaagx►rting.haraanants waste hauler: ! <br /> Name: Nor-Cal Whsle ON hooters Haider Registration M CAU 901417255 { <br /> Address: 1'.0. Box 645 City: Denair, CA Zip: 9531f <br /> 1'iurrc: (209)332-0110 <br /> 7. Decontandnantom•1'rrtcedares: <br /> • i <br /> A. WilffankOs)and piping be decontandnaled prior In removal? YUS 1X1 NO i I. <br /> ' r <br /> b. IdcnNry conUactnr perrotming decontanrttaation: i <br /> i <br /> Nance: Jim 11wrpe Oil Co., Inc. <br /> Address: 351 N. Uocknran Road/r.V. Box 357 City: Lodi,CA Zip: _95241-0357 j <br /> Phone No. J2091461-4501 or(109)360-6175 <br /> C. Descrilrc nocilmd in be used for demutaminalion: ' <br /> 'Tanks and 1►llting will he Irlple rl"tol with boll water and biodegradable soap solullon. <br /> ' i <br /> d. Describe(taw titrsale maletial will be slored on-she prior to manifesting off-site: <br /> The ritttale Will Ire rrntovedl by Jill,Illrorpe(Hit-Inc,personnel and Ile placed in drtnt". 'lite <br /> dr ons will he tabled and slored ort site awalfing pick op for disposal of a proper disposal <br /> facility. ' <br /> e. Ithisate Ilaorler aril peonolncoi'1'teatnreaN� Storage&Disitosaai Iracility: <br /> I larder Name: SanK as No.f Ilaotler Itegialralion N: <br /> Address: City: Zip: <br /> Phone No, <br /> Pennhted Dislxtsal Site: Refineries Services,l'altcraon, CA,or other approved fadlily. <br /> Pop 4 <br /> i <br />