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I. (a) Is(here s 1'115-UIII)conhnctor's qucsliounmire ou rile or enclosed'I YUS IXI NO I <br /> (b) is the cottenl certificate of worker's coogleasA(ion hlSoralce on rile? YUS 1 XI NO I 1 <br /> (e) D(les lIle coolraclor Ixlssess a ,liatar(loos Sobs(arlce Itentoval CerlificAlloo7" YUS Ili) NO <br /> 2. Ifas a "Site Ilealltl d( SArcly I'laa" for Ihis job site heed subnd(led7 YUS I)q NO <br /> 3. flits a111dlcalrl petfllitldtlg tellloval In file(,try of Tracy 111)1aillell A "grading slid Uxcavalion PerinI0 <br /> N/A IX I YIIS I I NO I I If YIIS, 11cuolf N <br /> 4. 1104 c(loltaclllt 11111AIll"I allprovill (,,III, file I(ICal fire dellatlrllcln to perh1r11r (Allk coningl NA JXJ YUS J I NO <br /> 5. Is (llete kllllwledge or CVI(ICIN;e of leakRgc hill,the lnllk(x)no(II(tf pllllllg'1 (if yes, please explaill) YIIS J J NOIK <br /> 6. If fAllk resldoal exlsls, Ideolify Irauspolling 1137aldaos waste hauler: <br /> Nanlc: Nor-Cal Waste Oil haoiers Ilauler Itegis(rnllon N: CAI) 962417255 <br /> Address: 1',0. Box 645 City: Denalr, CA Zip: 95316 <br /> Phone: (209) 331-6110 <br /> I . <br /> 7. tleconlaminaliolri4ocednres: <br /> M. Will lade .1)And piping be decoolsudonfed prior In removall YUS JXJ NO I I <br /> It. Identify coollaclor perronning dcalnlanl8raflon: <br /> Nanle: Jim 1 hor ll a Oil Co., 61c. <br /> Address: 351 N. Beckulnn Rond/1'.0. Box 351 City: Lodi# CA Zip; J05241-03 7 <br /> Phone No. (209)461-4581 or 1203 368-6175 <br /> C. Descrillc nlelhad to be used ror declnllalnFllalioo: <br /> I <br /> 'I'Allhs and plphlg will he It Iple rinsed lvith hol wnfer sad blodegra inlde Romp solo(lon. <br /> d. Describe how thlsAle nlaleriAl will be sloced on-rile prior to ntnolresdog off-site: <br /> 7 he unsafe Hill be removed by Jhu 'Thorpe(ill, Ines persmalel and be placed ht drunB. The <br /> III ol1U 1011 Ile Imtdell moll 5101011 no site 9lvalihlg Irick fill for disposal of n proper disposAl <br /> i <br /> laclllly, _ <br /> e. Itlllsale Ilalller Arld pelluilled i'lealnletll, Slotage& Ulsposal flaclllly: <br /> IlAnlet Nalne: Snore AS No. 5 1laolet Regislrndoll <br /> Address: City: Zip: <br /> Phone No. <br /> Pennilred Disposal Site: IleUneries Ser vices,Patferson, CA, or other approved facility. <br /> Page 4 <br />