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1. <br />2. <br />3. <br />4. <br />S. <br />6. <br />M <br />(a) is there a PUS-EIID contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation Insurance on tile? <br />(c) Does the contractor possess a Mazardous Substance Removal Certification'? <br />lies a 'Site Health & Safety Plan' for this job site been submitted? <br />fins applicant performing removal In the City of Tracy obtained a 'Grading and lxcavatfon Permit'? <br />N/A r, YES [ [ NO [ j "YES, Permit # <br />lies the contractor obtained approval from the local fire department to perform lank cutting? N YES[ ] 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 Nor -Cal Waste Oil haulers <br />Address 11.0. Box 645 <br />Phone # ( 209 ) 332-8710 <br />city. <br />Haider Registration # CAD 982417255 <br />Denair, CA Zip 95316 <br />Decontamination Promdores: <br />a. Will tank(s) and piping be decontaminated prior to removal? YESPA <br />" NO [ ] <br />b. Identify contractor performing decontaminations <br />Name Jim Thorpe 011, Inc./ DESA 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 JTO/RMC Elaz Mat. hauler ti 2667 <br />C. Describe method'- be usW for decontamination: <br />Oil File at RISMIUD <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />"be r i nsea t v will he y Jim "Thorpe Oil, Inc personel and placed in <br />difulls The drrm 1 wi t t (,r�0SyQrted by us to our yard at 807 [Slack Diamond <br />Way, Lodi, CA to await pick up by a qualified collection company. EPA #CAL 000012884 <br />e. Rinsate Hauler andpermitted! Treatment, Storage & Disposal Facility: <br />Hauler Name Same as N 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 />