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1. Is there a contractor's questionnaire on file? NA [ J YES [V� NO [ J <br />a) Is the questionnaire enclosed? YES [ ] NO [ ] <br />b) Is the current certificate of worker's compensation insurance on file? YES [ j NO [ ] <br />C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES (i� NO [ ] <br />2 Has a "Site Health & Safety Plan" for this job site been submitted? YES [�']' NO [ ] <br />3. Has applicant performing removal in the City of Tracy, obtained a "Grading and Excavation Permit"? <br />N/A [ ] YES [ ] NO [ ] If YES, Permit # <br />-4. Have tank(s) o piping ending removal leaked in the past? (If yes, list tank #) YES [ ] NO [ <br />5. What will be the disposition of the tank(s)piptn <br />f'lptPW To do N[ayV� To N * N S91PYA9r> <br />6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[VjYES[ ] NO[ ] <br />7. Decontamination Procedures: <br />a. Identify contractor performing decontamination <br />Name P,QRADISO ��NSTRV�-'��0� <br />Address PO. C'�ox 1830 Ctty ss.► t.+oao Zip 94511 <br />Phone No. Sto S4,2.• ss�l <br />b. Will tank(s) an pipi be decontaminated? YES [ ] NO [�}- <br />C. Describe method used to clean tank(s) and/or piping (If noc in contractor's file): <br />"Co►.►1LS Tv 2 , r1 - <br />d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br />3. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br />a. Residual/Hazardous Waste Hauler <br />Name " 0 N F-WIV40toAg;kA-L—rA SHIP Sc-t"N lG� <br />Address 220 C1419A 6A5uJ <br />City SAN.` lsco State Ge Zia 94tc'7 <br />Phone No. (415 ) 543,4S35 Hauler Registration # Lr—. M 03-b4- <br />Disposal <br />334Disposal Site Z20 C41KA BAS1P1 F-J?A S CAb 004'1TAV Cob <br />Page 4 <br />