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1. (a) Is there a PHS•EHD contractor's questionnaire on file or enclosed? YES [v]/ 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 Ce tiflcatiou' YES [y NO [ ] <br /> ?. Has a 'Site Health &Safety Plan' for this job site been submitted? YES 41 NO [ ] <br /> 3. Has ap cant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A [% YES [ ] NO [ ] H YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAk YYES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [� <br /> 6. If tank residual exists, identify transporting tiaza:-dous waste hauler. <br /> Name Amerman awy[]lwEi l Hauler Registration # �nt� 115 <br /> Address ,kn6y deer City -ruviocy- Zip 6155 5 <br /> Phone # ( 0 dU <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES kj-'NO [ ] <br /> b. Identify contractor performing decontamination: <br /> r7 E <br /> Name 1aydVraVa4i i/ -Tr-,O- <br /> Address p <br /> Address 1� d]'-arp City Zip 4/-53(,V,0 <br /> Phone No.( Z ) 5aq - 234, <br /> C. Describe method to be used for decontamination: <br /> bntC. wt/1 �v Yl�ol e VI near cl <br /> d. Describe how rinsatq material will be stored onsi a prior to manifesting oftslte: <br /> (]�llrn� lea rr�f S I,Yttil Y2ht�VP1 +1DYrl Si <br /> a Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: £� <br /> Hauler Name minViYn N Valley L—�i1VI(,6Wtlgauler Registration <br /> Address X430 rlf- W, JI 1I11City TlIrICC1L- Zip ,L,5- L <br /> Phone No. ( AD ) 713x' -' b46- <br /> �� <br /> Permitted Disposal Site pm po-eVw <br /> Page 4 <br />