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I. a) Is there a PHS-EHD co tractoes questionnaire on file or enclosed? n . i►C;Lv4(Es yj NO ( J <br /> b) Is the current certificate of worker's compensation insurance on file'? YES [)(] NO( j <br /> c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [Xj NO[ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES (Xj NO[ J <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A (X J YES [ ] NO O If YES. Pennit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? <br /> NA(X] YES [ j NO l <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? YES ( ) NO [ ] <br /> (If yes,please explain) No.see Appendix C <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name f_n a c g._So w`S Hauler Registration # O O 19 <br /> Address _ aSS haMrL _11 1-,N D . Cityj?at-a►rnowD Zip 9 y$0 1 <br /> Phone No. ( S 10 ) a 35 - 139 3 <br /> 7. ' Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES [ J NO 6C] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No. ( ) <br /> c. Describe method to be used for decontamination: <br /> N I la <br /> d. Describe how rinsate material will be stored on-site prior to manifesting off-site: <br /> N.1 Iq <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name N 1q Hauler Registration # <br /> Addmss _ City Zip <br /> Phone No. S ) <br /> Permitted Disposal Site <br /> 4 <br />