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t. (a) Is there a PHS-EHD eoaUIC r S qusstiortnai*on ft or taclo"? YES [ ] NO [4' <br /> (b) Is the current certiiicat$of workoa's oampea"dou bourance on filet YES NO C 1 <br /> (c) Does the contractor possess a 11axw4m Substnim Renwas1 Cwtificatlim ? YES W---'NO [ 1 <br /> 2. Has a "Sita Hatlth&SR&q VW for 11113 job$119 bora submitted? YES W--'NO [ 1 <br /> 3. Ilan app <br /> 11 t porform� &=oval In the City of Tracy obtained a `Gr WOM and I�vation Permit'? <br /> NIA YES [ ] NO ( if YES] Permit # <br /> 4. Has the contractor obtained approval hvn tiro local fico department to perform tank cutting? NA[ 'iS C 1 N u l I <br /> 5. Is there knowledge or evidence of lealwge hVaa thr tanks) and/or piping? (If yes, please explain) 'YFS [ l N[) [.r"- <br /> 6. If tank residual 4exIsts, identify transporting haTArdot S waale hauler+ <br /> Name ska-RY l&L.2, __..Hader Regis4utiou <br /> Address/,? y/ o_ &G�31 Cl <br /> t7 zoc C`�Q _ Zlp„ <br /> phone # ZO r 7y <br /> 7. Decontamination Proccd <br /> a. Will tank(s) and piping bo decontaminated prior to removal? YES Iq--"NO [ 1 <br /> b. Identify contractor performing decoutauainatloau <br /> Name w { / <br /> Address Mo. c�r) �� City� � �DLJ- zip n <br /> Phone No.( ' G <br /> c. Describe method toAq used for decontaminations <br /> d. nesciribr, bow riasate material will be stored ousito prior to manifesting offs <br /> .,J <br /> r <br /> Y O <br /> e. Rinsate Hauler and pcnmi#d Treatment, Storage & Disposal Facility: <br /> Hauler Name Hauler Registration # til _ <br /> Address 1333 1 _ 43 city a zip 3�3 <br /> (,-*'U� � 0q? - �7 Z <br /> Phone No. =-a---� <br /> Permitted Disposal Sato - <br /> Page 4 <br />