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1. (a) Is there a PHS-EHD contractoes questionnaire on file or enclosed? YES 0 NO [ ] <br />(b) Is the current certificate of s compensation insurance on file? YES O NO [ ] <br />(c) Does the contractor possess a tion'? YES [A NO [ ] <br />2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES V NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Ekcavation Permit". <br />N/A M YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO[ ] <br />S. <br />6. If tank residual e3dsts, Identify transporting hazardous w te hauler. <br />Niunea2aW <br />a. Will tank(s) and piping be decontaminated prior to removal? YES 0( NO[ <br />b. Identiry contractor performing decontamination: <br />Addressad5c)'1 1 ''cityd <br />Phone No. <br />r� <br />,; used , <br />r 7t <br />d. <br />®► <br />e. Rinsate Hauler and permitted Treatment, StorageDisposalHauler Registration <br />Address 221 aI /1 <br />Phone No. <br />Permitted Disposal Sltee-,VDi Y LL/ <br />Page 4 <br />