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1. Is there a contractor's questionnaire on file? ;tg1V NA [ j YES [ ] NO [x] <br />a) Is the questionnaire enclosed? Imo( II II nn (( YES [t] NO ( ] <br />b) Is the current certificate of worker's compensation insuiaita rin7fite'l'2 YES [t] NO [ ] <br />C) Does contractor possess a 'Hazardous Substance RM�qp 6li41r NA [C] YES [ ] NO[] <br />PT iFMIT/SERVICES <br />Z Has a 'Site Health & Safety Piano 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 [X] YES [ ] NO [ ] S YES, Permit # <br />4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES [ ] NO (X] <br />5. What will be the disposition of the tank(s)/piping? <br />H&H - scrap metal <br />1.i <br />Ya <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[%] YES[ ] NO( <br />Decontamination Procedures: <br />a. Identify contractor performing decontamination <br />Name H&H Ship Service Company <br />Address 220 China Basin Street C lty San FranciscoZip 94107 <br />Phone No.( 415 ) 543-4835 <br />b. Will tank(s) and piping be decontaminated? <br />C. Describe method used to clean mnk(s) and/or <br />is no <br />YFS [ j NO �] <br />(If not in contractor's file): <br />ien sent to H&H for steam cleanin <br />d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br />8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities <br />a. Residual/Hazardous Waste Hauler <br />Name H&H Ship Service Company <br />Address 220 China Basin Street <br />City San Francisco State CA Zip 94107 <br />Phone No. 4( 15 ) 543-4835 Hauler Registration # 0334 <br />Disposal Site Same <br />Page 4 <br />