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h there a contractor's questionnaire on file? NAI j YES tj NO f I <br /> a) Is the questionnaire enclosed? YES E ) NO <br /> b) Is the current certiffeaie of worker's compensation insurance on file? YES 10 NO ( j <br /> c) Does contractor possess a 'Hazardous Substance Removal Actions Cert "? NA ! J YES 14 NO <br /> 2 Hasa •Site ileallh & Safety Plan' for this job site been subntirterl? YES ( NO <br /> a) USA underground utilities will be notified prior to excavation <br /> 3 Has applicant perfortning remOvat In the City of Tracy obtulned a *Grading and Excavullun Pgrull1"7 <br /> NIA tt YES ( ] NO j I If YES, Permit # <br /> 4 Have tank(*) or piping pending removal leaked in ilie past? YES NO ( ) <br /> Urti<n4wn <br /> S What will be the disposition of the tsnk(s)Iplping? <br /> .� Pining will be triple rjj)§e(j gnd 41sagse4 o <br /> as ArraD. - -- ---- ---- - - - <br /> 6 Has the contractor obtained approval from the local fire department to perforin tank cutting? NAI I YESjyj NOj 1 <br /> 40 Decontamination Procedures. <br /> a Identify contractor performing decontaminadon <br /> Name Jim Thorpe Oil T11c. d.b.a. Rich-- Mart Construc.tioij <br /> Addtes$3ckman Na. 7 pa bx City LWI ZIP 9524 1--035 <br /> Phone No.( ) — <br /> 6175 <br /> b Will lank(s) and piping be decontaminated? YES Ix) NO I I <br /> C Describe method used to clean tank(s) and/or ppiping (if nor in contractor's file): <br /> Tile tank (s) situ associated pip3oe, will be i.riple r'i+tse;d on site by <br /> J.T.U. / Mh--ffirt Const. Cleaning procedure wi I I consis o ren <br /> rinses with seam or hot water. flinsate procedure is an file in your office, <br /> d Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> Ri nsate will he c mnyed_Eyou, Me_tank (�3}.. .kly- ,111a Tharpe Oil I H 1r1Ld3rf -- <br /> !^ Cnnat Wt.in" Ha ZnVj1ntiq Wa.gL1e tlaulert fla.tt- iiEgl�t.raLID;z N 27th7- _-__ <br /> `f'hn ringata will tin 13L)nrted I:y ej.� truaur yard <br /> l <br /> 8 State Registered Hazardous Waste Haulers and f ermtlicd DispAsal FAcilities <br /> a Residual/I-iazardous Waste liauter <br /> Name <br /> Address o <br /> Cily Den r Ca. q91 16 Some Zip <br /> Phone No. 131 U�1 332-87 Hauler RegisU ullon #CAD 982417255 <br /> r <br /> 5 <br /> Page 4 <br />