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J <br /> 1. (a) Is there a PIIS-EIIU contractor's questionnaire on file or enclosed? YES)Q NO ( ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES NO [ ) <br /> (c) Does the contractor possess a 'IlaiasnkKo Substance Rraatoval Caztillalion'? YES NO ] ] <br /> 1, ling a The Ilcatth & Safdp Plan' for this Job site been submitted? YES R No ( ] <br /> 3. Has applicant performing removal let the City of'frac! obtalned a 'Grading and ascavailon 1'erenim <br /> N/A YES ] ] NO ] ] If YES, Permit # <br /> 4. Has Ilse contractor obtained approval from ttse local fire depariment to perform lank culling? NA <br /> ,KYESI ] NO. <br /> 5. Is there: knowledge or evidence of leakage from Ilse lank(s) and/or piping? (it res, please explain) YIDS ( ] NOIN <br /> i <br /> b. If tank residual exists` Identify transporting hazardous waste haulers <br /> Name Hor--Cil Waste Ui 1 hattl.(nrs Ilaulew Registration 0 CAU 9824 17255 <br /> Address 1'.(.). Box 645 City Berrair, CA ?Ip 95316 <br /> i <br /> Phone * ( 209 l 332-8-110 i <br /> 7, Deconlamlreadon Procedures <br /> A. Will lank(s) ■nd plping be decoutamhsaled prior to removal? YES No [ ] <br /> b. Identify contractor performing decontaminations <br /> Name Jliu Tlior•lw Oil , [sic./ 141A Wich-Mar•L Coai3I1rucLlou <br /> i <br /> Address 351 W, lle-cklwlel l ME// 1-0- BOX 357 Clly I.-od l I CA ZIP 95241-0.357 <br /> Phone No.( 209 ) 462-45131 .1'In/llM(' Il;nz 11al.. liatilee• # 2661 <br /> C. Describe method 4o be for deeonlaminaitons <br /> Uzi rile aL Po be <br /> d. Describe how rhisate material will be stored onslic prlor to maniresting offshes <br /> 'flip vinaPal." will- t- rewczved by Jliu Thceiye 011,, tile, pel-suie?l arid) placed lei <br /> llunlls 'lire elI•rnua will be. Lvalrtil)ol•Le:dl by us Lo_oul• yat•cl at 1307 Black Diamond <br /> Way, Lexi I , CA to await 1►1c1< ul) l►y it sinal i fieri col l.ecLfon colnimoy..EVA VAL 0000128011 <br /> e. Musette hauler and permitted"Treatment, Storage & Disposal Eaclillys <br /> hauler Name Sartre as # 6 Mauler Reglsarntlou # <br /> Address City Zip <br /> phone No. <br /> Permitted Disposal Site Hefleserles Services I'aLCee•son, CA or oilier approved facl1.1Ly. <br /> Page 4 <br />