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i. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? <br /> YES [A No [ 1 <br /> (b) L the current certificate Of worker's compensatlon insurance on tile? <br /> YES [X] NO [ J <br /> (c) Does the contractor possess a `Ilamrdoaa ftboLRDM Renao*a1 <br /> Cerlltfation'? YES M NO [ J <br /> 'Site IIe:Itlr &Safety Pian'for this Job site been submitted? YFS [)J NO <br /> z, Has s , <br /> 3, Ilse applicant performing removal In the City of Tracy obtained a 'Crad�and Emmvatlon Permit'? <br /> NIA �, YES E J NO [ 1 U YES, Fermi <br /> he local fire department to perform tank cutting? NAPq YES[ J NO( J <br /> 4, Has the contractor obtatned'approral 14nm t <br /> Is there knowledge or evidence of leakage from the tank(s) and/or piping? (it yea, please explain) YES [ J NO ; <br /> Y <br /> 6. If tank residual exists,,Identify transporting hazardous waste houlerl y <br /> IIaufer Re&tratIM#CAD 982417255- <br /> l "` Name - Oi. Waste oil, hauler r <br /> y Addrtas p n- HoX 645 Clty Ca. Zip 95316 <br /> Denair, �. <br /> f <br /> .phone # ( 2 g } 33 1-870 <br /> 7. , Decontamtnatlon Proeedurem <br /> TY,III tank(s) and piping be decontaminated prior to removal? yES NO [ )_ . <br /> b. Identify contractor performing decontaminatloni ` 4 <br /> Nems Jim Thorpe Oil, Inc./ DBA Rich-Mart Construction <br /> 351 N Beckman Rd. ~ City <br /> `Lodi Zip 95240 <br /> .. .Address <br /> Phone No. 2( , 368-6175 / 462--4581, ! <br /> C. Describe method to be used for deco ion. <br /> Rio <br /> ideals. `� <br /> nsatc aaeterlsl will be stored onsite prior to manifesting offsltes <br /> d. Describe how rlearb 11 <br /> Rinsate will be stored in i <br /> e sealed and labeled until <br /> e. Rlnsate Hauler and permitted Treatment,Storage & Disposal Facilltyi 255 <br /> ' IIaaler Re&txattoir # CAD 8241 <br /> Bauier Name No — <br /> City Denair, Zip 95316 <br /> Address <br /> t <br /> Phone No. (_ 209- } 332 � �—` <br /> permitted Disposal Site Refiner <br /> Patterson Ca. or other caLity. <br /> -page 4 <br />