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%wool <br /> NA ( J YES� No } J <br /> I. Is 111ere a contractor's questionnaire on file? YES NO <br /> B) Is the ques(lonnaite enclosed? <br /> b) Is Ilse current certificate of worker's conipensallon Insurance on file? No <br /> YES �;} } } <br /> C) Does conlractor possess a 'I laratdous Substance Removal Acllons Cert.'? NA [ ] YES No <br /> 7. I las a `Site Ilenllh Al Safety Plan' fur tills Job site been submitted? <br /> YES �(] No J J <br /> uruier�;i ��t�ixi ul,i_IiLi <br /> will be nc�L31'.ic�ci prior Lo excavation. <br /> ). I la$ applicant performing temtrval in lire City of Tracy oblalned a 'Gradin& acid Excavalion PerntH'? <br /> NIA YES ] } No ( } If YES. Permit # <br /> YES NO J J <br /> 4. have lank(s) or piping pending removal leaked In the I}ast? Urnkri wii <br /> 5. Wlrat will be Ilre disposition of the lank(s)/piping? LA-.L�1 lt� ill 1�tL► e •jilset alyd dIs PUsecL j-RL— <br /> -ad-}lcralJ- <br /> 6. I IRS e conm lractor oblaitied apluoval froIlio lofir <br /> cal e deparuuent !o perform tank cutting? NA( J YESly <br /> thNO( <br /> ] <br /> 7. Deconlaminallon Procedures: <br /> a. Identify G <br /> conuaclor perfortrtin& deCOnlalnindllon � � <br /> Nance Jirn '1'llar•1)e Oil 11,c. d.l).a. Rich- Mari: Constructloll <br /> AddresS15"-Recicnrari Flc . po. >x. 5 ly � i ?.fir <br /> Phone No.( _�)�—�-��i� <br /> YES IXJ NO } ] <br /> b. Will tank(s) and piping be decontanrinaled? <br /> C. Describemethodaseatid lassociaLed1tpilfipi�6 il.lnot <br /> l)ley L1-'ller'-"1!3- Oil site Iry <br /> 7'lie Lati4c ( ) g—ro eed� ire Wl-n conns}S� free <br /> ic1I-Fr�ConsZ'.Ieaninl; P <br /> rimes taitfi gCeaiit or lio�t7ater T t nsa a proceiiilre i s on—T1e—in yorar o s ce. <br /> d,. Desctibe how rinsale material will Ue stored on site pilot to ntanifesling otn_LSile: <br /> ►eta <br /> �f:t�tisLuiLL.1_i.tu-11az.'_mkA blast e_143fti�r-.-11a <br /> u 1�r�ii:gisLr�t Li�l�iiLtd- <br /> �_:ac•.ecLl.tult�t„� aiiciJ.t�tisii <br /> �.�f'A CAi. KIDG-1211#i1i - — <br /> ��t.�3f 1• tc�i tct Jd=�y�uli.,-..�a <br /> g. Stale Registered Ilazatdous Waste haulers and I•errnitted Disposal facilities. <br /> a Residual/Ilazardous Waste hauler <br /> Name AO -C Ol aste oil ole s <br /> Address U-01] r Slate _� Zip <br /> City Delta r' Ca. 5316 Ilauler Regislrullun CA <br /> # D 95241 255 <br /> Phone No. p(_oo ) 332 T10 <br /> U. L?vciit.tt �J. (l i sl)()s.rj.l. ()ror rothereamay <br /> provediidisposal Kaci]it,y eririeies Service 13331 N. Hwy. 33 <br /> 1' person, Ca. 9363 Page 4 <br /> r <br />