REMOVAL_1996 - Laserfiche WebLink

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I. (a) Is there a PIIS-E111)contracfor's queslionuaire on rile or enclosed? YES IXI NO I I (b) Is the current certificate of worker's compensation insurance oil file? YES 17Q NO I I (c) Does the conlraclor possess a "I lazardous Substance Removal Ceti i ficalion?" YES IXI NO I I 2. Ilas a "Site Ileallh&Safely flan" for This job site been submilled? YES I7Q NO I I 3. I las applicant performing removal in the City of'I'racy obtained a "Grading and Excavation Permit"? N/A IX I YES I I NO I I If YES, Permit k 4. tins conoaclor obtained approval from the local fire deparlmeol to perfoun lank culling? NA IXI YES I I NO I I 5. Is There knowledge or evidence of leakage from the lank(s)and/or piping? (If yes, please explain) YES I I NO 14 6. If lank residual exists, identify transporling hazardous waste hauler: Name: Nor-Cel Waste Oil broilers Ilauler Regislralion p: CAD 982417255 Address: P.O. Box 645 City: Denair, CA Zip: 95316 Thune: (209) 332-8710 7. Decomamioalion'Procedures: R. Will Ianko s) and piping be decoutaminaled prior to removal? YES IXI NO I I h. Identify conlraclor performing decontamination: Name: Jlnr Thorpe Oil Co. Inc. Address: 351 N. Beckman Rond/P.O. Box 357 City: Lodi, CA Zip: 95241-0357 Phone No. 52091462-4581 or (209)368-6175 C. Describe medrod to be used for decoulamivation: Tanks and piping will be Triple rhtsed with hof Willer and biodegradable soap solution. d. DescHhe how rinsale nralerial will be stored ou-sife prior to manifesling off-site: The rinsnle will Ile reproved by.111m 'Thorpe Oil, life., personnel and be placed In drtrns. The drums will be tabled and stored ml site awnililrg pick trip for disposal at a proper disposal facllily, e. Rinsate Ilauler and permitted 'I'realmeol, Storage& Disposal Facility: Ilauler Nanre: Same as No. 6 Ilauler Registralioo p: Address: City: Zip: Phone No. Permitted Disposal Site: Refineries Servicts,Pidlerson, CA, or other approved facility. Page 4