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1. <br />2. <br />3. <br />4. <br />S. <br />EM <br />H}I contractor's questionnaire on Me or r c' I NO <br />t the current certificate of worker'scompensation insurance on <br />Does te contractor possess - : 'Hazardous r r ;:. Removal , r _ .':1 r' r c: t O <br />' . o t r .'r r. r : +t a r -T, <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation PeI <br />N/A [ ] YES DO NO [I If YES, Permit # "o 0 Fj LV. " <br />: a 4-v74- ;:� t r t _t ..at r r.'. t rrii r. ir: t s wt' JOYNg t oil <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES 1$ NO [ j <br />Pe roleum hvdrocabons have been detected in soil and ground <br />water at the site. <br />If tank residual exists, identify transporting hazardous waste hauler. <br />Name Erickson HaulerRegistration # CAD 099 466 3,92 <br />Address 255 Parr Blvd CIty Richmond <br />Phone # ( 415 ) 235-1393 <br />Decontamination <br />a. Will tank(s) and piping be decontaminated prior to removal? <br />M <br />2 <br />Pa <br />Identify contractor performing decontaminations <br />Name Golden West <br />Zip 94801 . <br />Address 567 Exchange Court City Livermore Zip <br />Phone No.( 510 ) 447-2484 <br />Describe method to be used fordecontamination: <br />Rinse tanks and lines <br />94.550 <br />Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Lines flushed into tanks prior to vacuum truck removal. <br />Rinsate Hauler and permitted Treatment, Storage & DIsposal Facility: <br />Hauler Name Erickson <br />Hauler Registration # CAD 099 466 392 <br />Address 255 Parr Blvd City Richmond Zip 94801 <br />Phone No. ( 41 5 ) 235-1393 <br />Permitted Disposal Site <br />„, • <br />