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I. (a) Is there a END contractor's and subcontractor's questionnaire on file or enclosed? YES NO[) <br /> (b) Is the current certificate of worker's compensation insurance on file? YES NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES V NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> hazardous waste site in accordance with CCR Title 8? YES V NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES V 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. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[J YES[�'Iv'O[] <br /> YDS, Fi2E Fc9n 0/0rv6 `srcr�ific�a�Owi j O�SPI'�ix-rL <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO 11" <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: 1jP1fV 6 CA14-Y <br /> Name Hauler Registration# <br /> PIA <br /> Address City Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES["J NO[) <br /> b. Identify contractor performing decontamination: <br /> NameV. Ako' .S <br /> u <br /> Address /0( IIL©a.'OtM City 6,4aO&A-A Zip ypzyg <br /> Phone No.( 3iv ) 523 '4/V30 <br /> C. Describe method to be used for decontamination: <br /> RC/�Cr1F pit�,Na:.y SE��oy3 94�,5,4 Oi/moiyc v.ar�E D2yr a,v6 OaGy E v� /.v7o 5S 6aG. <br /> CJ2U*�1�Co.v7i,,.•uE� lD /J2Ara+ AiP-✓e A!°76'{. FCU.�'.I>N6 6.v'1•[c .9GG Giq c.v i��s .cid <br /> (7rLF+rtivwr <br /> 65 644 Ck- R/N-$ 76- �c..�c w:c� g - �o�crca� F�ebr /!�.✓7 Z� ,,cam of Pf'� <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> ,R1-jSi1TC- �RO.�I ?��°i�lc LBc S7cAI;6r `v�0 65 6;Icr V O•=t, <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name G. U. /90/1-V6 Hauler Registration# 32 i 6 <br /> Address 906 C. City i�WLTv A Zip %Vz I <br /> Phone No.( 310 •-Y! 30 <br /> Permitted Disposal Site WA-S76- <br /> EH <br /> AS76EH 23 046 (Revised 07/31/08) 4 <br />