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0 <br />1. (a) Is there a PHS-E33D contractor's questionnaire on file or enclosed? YES [ ] NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on isle? YESJ4 NO [ ] <br />(c) Does the con a tion'? YES [ ] NO [ ] <br />2. Hasa Site Hed& & Sahly PIW for this job site been submitted? NO[ ] <br />3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br />N/A [ ] YES [ ] NO [I H YES, Permit <br />4. Has the contractor obtained approval fromthe local fire department to perform tank cutting? NA[ ] YES[ ] NO[ ] <br />S. Is there knowledge or evidence of leakage from the (s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br />6. If tank residual exists, identify trimsporting hazardous waste hanler. <br />Address a... '.S ,Y,.. Zip <br />a <br />Phone 9 9 <br />1. Decontamination Procedurm <br />a. MU tank(s) and piping be decontaminated prior to removal? YES[] NO [ ] <br />b. Identify contractor performing decontamination: <br />Namei <br />PhoneAddress4iB P. :s&Nlrez- *to( city RZ6,00 zip <br />C. Describe method to be used for decontamination: <br />d. Describe how ,,rinsatematerial will be t onsite prior r manifesting r 1 <br />t1 -4SL�66 <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />i ' u l' rt:.•. a.9. ' ':. E11' A:a:: r .. <br />Address citv zip <br />.. .r; yylr: <br />Phone No. <br />Permitted Disposal Site <br />