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1. <br />2. <br />3. <br />4. <br />5. <br />2.2 <br />7. <br />(a) Is there a PHS-EIID contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation Insurance on file? <br />(c) Does the contractor possess a 'Hazardous Subshmm Removal Certification'? <br />Iles a 'Site Health & Safety Pon' for this job site been submitted? <br />Lias applicant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit'? <br />N/A YES [ ] NO [ j 1f YES, Permit # <br />Iles the contractor obtained approval from the local fire department to perform tank cutting? N YES[ ] NO[ j <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ i NO <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name Nor -Cal Waste Oil haulers Hauler Registration v-, CAD 982417255 <br />Address P.O. Box 645 City Denair, CA Zip 95316 <br />Phone # ( 209 ) 332-8710 <br />Decontamination Procedarra <br />a. `Viii tank(s) and piping be decontaminated prior to removal? <br />b. Identify contractor performing decontaminatlont <br />Name Ji.tn Thorpe 011, Inc./ DBA Rich -Mart Construction <br />Address 351 N. Beckman ► Rd./ P.O. Box 357 City Lodi. , CA Zip 95241-0357 <br />Phone No.( 209 ) 462-4581 J'TO/RMC 11az Kat. hauler # 2667 <br />C. Describe methodbe used for decontamination: <br />On File at �o ISM81 <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Way, Lodi, CA to await pick up by a qualified collection company. EPA #CAL 000012884 <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Same as # 6 Hauler Registration <br />Address City Zip <br />Phone No. ( ) <br />Permitted Disposal Site Refineries Services Patterson, CA or other approved facility. <br />Page 4 <br />