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1. (a) Is theft a PIIS-EIID contractor's questionnaire on Hie or enclosed? YES)Q NO ( ) <br /> (b) Is file current cerllRcaie of worker's oompensatlon Insurance on file? YES W No I I <br /> (c) ores the contractor possess a 'llazardous Substance Removal CeatificationV YES A No I I <br /> 2, lies as 'Site Ilealth A Safdy Pau' for this Job site been submitted? YES Pi NO I ) <br /> 3. Iles appllcud performing renvoval In the City of Tracy obtained a 'Grading and Excavation Permit? <br /> N/A P1 YES I I No I I If YES, I'ermll Ar <br /> 4. Iles the contractor obtained approval from the local Sce department to perrorms lank cutting? NAKYESI I NO. <br /> S. Is there knowledge or evidence of leakage from Ilne lank(s) and/or piping? (If yes, please explain) YES I I NON <br /> 6. If dank residual exists, Identify transporting hazardous vacate haulers , <br /> Name Nur-Cal Wasl.e Oil haillers Ilauler Reglslrafion At CAD 902417255 <br /> Address P.O. Dox 645 City Denair, CA Zip 95316 <br /> Phone M ( 209 1 332-!1'110 <br /> 7. Decontamination Procedures: <br /> ■. Will lank(s) and piping be decontaminated prior to removal? YES NO I I <br /> Is. identify contractor performing decontaminations <br /> Name Jim '1'lior•pe Oil , Inc./ DILA 111cb-M1rL ConsLrrucLion <br /> Address 351 N. Deekulau Hd./ P.O. Dux 357 Cid. Lodi ,CA Zip 95241-0357 <br /> Phone No.( 209 1 462-4501 J'I'O/HNC Ilaz. ML . hauler p 2667 <br /> C. Describe method o be n <br /> for decontaminations <br /> On Fl le al. �'NS/r111) <br /> d. Describe how rinsale material will be stored mslle prior to manifesting oQSNa <br /> The ri:lgeaLe will be remuyed by J1w-fhun-ve Oil, luc, uersouel and placed In .. <br /> dnnnan9- 'file di-imus will be LrausoorLed by us Lu out- yard al. 007 Black Diamond <br /> Way, L(xli , CA Lo await pick up by a qualified collection company. EPA VAL 000012004 <br /> e. Itlnsele Hauler and permitted 'frealment, Storage h Disposed Facillly: <br /> [fouler Name Same as U 6 Ilaoler Registration <br /> Address City Zip <br /> Phone No. (_ <br /> Permitted Disposal Site Hef)uerles Services Patterson, CA or other approved facl)iLy. <br /> Page 4 <br />