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L <br /> 1. (a) Is there a PfiS-EIID contractor's questionnaire on Elle or enclosed? YES NO [ ] <br /> r. (b) Is the current certificate of worker's compensation Insurance on flit? YES NO [ ] <br /> (c) Does the contractor possess a "Ha?ardom Substance Removal Ccrtlflntlon'7 YES JX NO [ ) <br /> 2. Has a 'Site Uadth &Saifeiy Plan*for this job site been submitted? YES P( NO [ ] <br /> w 3. lIns npplicant performing removal in the City of Tracy obtained a 'Grading and Frcavation Permit"? <br /> NIA YES [ 1 NO [ ] If YES, Permit <br /> 4. Iles the contractor obtained approval from.the local fire department to perform tank cutting? NAXYES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO,[� <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler: <br /> y Name Nor-Cal. Waste Oil haulers CAD 982417255 <br /> Iianler Registration # <br /> Address P.O. Box 645 Clty Denair, CA Zl 95316 <br /> �.. P <br /> Phone # 20(� 9 ) 332--8710 <br /> b,,7. Decontamins'tion Procedurm <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES NO [ ] <br /> b. Identify contractor performing decontaminatlom <br /> -Name Jim Morpe Oil, Inc./ DBA Rich-Mart Construction <br /> Address 351 N. Beckman' fid./ P.O. Box 357 Clty Lodi,CA ZI 95241-0357 <br /> [� <br /> �. Phone No.( 209 1 462-4581 J11O/RMC llaz Mat. hauler # 2667 <br /> c. Descrl1c method be for decontaminations <br /> On File at PIIS/Mill <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> The cinspat.a will he Iz_pmoyed by-. ill) 2:1iorpg-, Oil, Inc. r eonel and laced in <br /> to r rd at 80Slack Diamond <br /> Way, Lodi, CA to await pick up by a qualified collection company. EPA #CAL 000012884 <br /> e. Itlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Same as # 6 Ranier Registration # <br /> Address <br /> . CIt7 Zip <br /> Phone No. <br /> Permitted Disposal Site Refineries Services Patterson CA or other approved facility. <br /> �. Page 4 <br />