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1. <br />2. <br />3. <br />4. <br />S. <br />r,, <br />7. <br />(a) Is there a PHS-EIM contractor's questionnaire on isle or enclosed? <br />(b) Is the current certincate of worker's compensation insurance on file? <br />(c) Does the contractor possess a Mazardons Substance Removal Cartinextion'? <br />Has a 'Site Health do Safty Plan' for this job site been submitted? <br />YES 6(1 <br />NO [ ] <br />YES R] <br />NO [ I <br />YES F1 <br />NO E] <br />YES 91 <br />NO [I <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Rnmyation <br />N/A [X] YES [ ] NO [ ] If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ I NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping`•' (If yes, please explain) YES [ ] NO [ ] <br />If tank residual exists, identify transporting hazardous waste hauler- <br />Name <br />aulerName Nor Cal Oil Co. Hauler Registradou# 2412 <br />Address P.O. Box 645 City D e n a i r Zip 9 5 316 <br />Phone( 800 ) 332-8710 <br />Decontamination Procedures: <br />a Will tank(s) and piping be decontaminated prior to ? YES Dc] NO[] <br />b. Identity con performing decontamination: <br />Name Oil Equipment Service <br />Address P.O. Box 950 City San Andreas Zip 95249 <br />phone No.( 209 ) 754-1808 <br />C. Describe method to be used for decor oo: <br />Triple Hot Water Rinse with Bio -Solve - Pump, transport and <br />dispose - Insert Dry Ice - Monitor LEL witch meter. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Pumped direct from tank to truck to transport to disoosal Site. <br />Hauler Name Nor C a l O i l Co. Haukr Registration # 2 412 <br />Address P.O. Box 645 City Denair Zip 95316 <br />Phone No. ( 8 0 0 ) 332-8710 <br />Permitted Disposal Site Refineries Services, Patterson <br />