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f'. c-, ... . ...� .. ..re.. .r.. �+..ilny; .wrsF:Lw.►lu v .1.. ar... r«.n .. •1 ai..7 r.. ... .L . <br /> A—,.- wl[t.i [ 1,: 1.,L.•':. <br /> 2. M-*a 'Site health&Safety Plan'for this job site been subrnittled? YUS NO <br /> 3. Has iicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A <br /> YES[] NO[] If YES, Permit#i <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAkYES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from,the tank(s)and/or piping? (If yes,please explain)YES[] NO <br /> i <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name ``�,,,V e' Hauler Registration#C,4Z00Q5'L7�j� <br /> Address-?d Zo 3-V-0 City��C j/ _ Zip S3�� <br /> Phone# 3 2-- [� <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES NO[J <br /> b. Identify contractor performing decontamination: <br /> i Name <br /> 1 <br /> Address,,351, /✓, /�y7 4) deo <br /> City I Zip <br /> Phone Not-41�99� <br /> C. Desc ' m thod to a used for econtamination: <br /> d. Describe how rinsate material will be stored o ite,prior tom ' estin o site: <br /> e. Rinsate Hauler and permitted Treatment Storage& isposal Facility: <br /> Hauler Name teA.- , G- Hauler Registration#! 4 �7t <br /> Address �O L' ���lS <br /> City 6—A— Zip <br /> Phone No. �) /Q <br /> Permitted Disposal Site <br /> �P�i.,9�s o��• o.z nT��%z ���Qo v��ciC r� <br /> EH 23 046 (Revised 11/2I/06) 4 <br />