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1. Is there a contractor's questionnaire on file? NA ( ] YES NO [ ] <br /> a) Is the questionnaire enclosed? YES ( ] NO [•� <br /> b) Is the current certificate of worker's compensation insurance on file? YES [v]� NO ( ] <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [-,---*NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES H' NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> NIA (v]' YES ( J NO [ ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank m) YES [ ] NO [,-K <br /> S. What will be the disposition of the tanks)/piping? <br /> P <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NApf/ ES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name _(Xo�,t) J,[_ tG T _b.lttrpFp <br /> Address lo(Q.o MINNe Sor/-,, AqENQZ City kb2ENTWDOV_ Zip oli-513 <br /> Phone No.(415 ) (c34 — tflqS <br /> b. Will tank(s) and piping be decontaminated? YES [ ] NO j ] <br /> C. Describe method used to clean tank(s) and/or piping Of not in contractor's fsle):. <br /> Tfz►P_L.E_ p.[NSED V-4MM �•lal'RDPRIP�T ,�aL1a�'1a.1 T45 Remora is <br /> AND 4 OlZ Sc..o.l.E Fl2oM -I NTERtiop of "f <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> S. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name EF?,kL.V 1*4, I WC-.. <br /> Address PA L.uD <br /> Cityp,1c MdND _ State C,&% zip So 1 <br /> Phone No. (S 1Q. ) Z J 3fj Hauler Registration # D I"I <br /> Disposal Site a u <br /> Page 4 <br />