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6 <br />v <br />(a) Is there a PDS•EIID contractor's questionnaire on Ole or enclosed? YES NO [ ) <br />(b) Is the current certificate of workers compensation Insurance on Ole? YES NO [ ] <br />(c) Does the contractor possess a 'Hazardous Substance Resound Certifiation'? YES NO [ j <br />lies a 'Site Health & Safety Pon' for this Job site been submitted? YES P( NO [ ] <br />Iles applicant performing removal In the City of Tracy obtained a 'Grading and Excavation Permit'? <br />N/A 10 YES [ ] NO [ ] If YES, Permit # <br />Iles /the contractor obtained approval from the local Ore department to perform tank cutting? NAK YES[ ] NO( j <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ j NO Itis <br />If tank residual exists, Identify transporting hazardous waste hauler: <br />Name Nor -Cal Waste Oil haulers <br />Address 11.0. Box 645 <br />Phone # ( 209 1 332-8710 <br />7. Decontamination Procedures: <br />City <br />Ilauler Regislratlon # CAO 982417255 <br />Oenair, CA 71,, 95316 <br />s. Mil tank(s) and piping be decontaminated prior to removal? YES NO ( ) <br />b. Identify contractor performing decontaminations <br />Name 'liul Thorpe Oil, Inc./ DBA Rich -Mart Construction <br />Address 351 N. Beclunan Rd./ P.O. Box 357 City Lodi,CA Zip 95241-0357 <br />Phone No.( 209 ) 462-4581 JTO/RMC Baz Mat. hauler 1) 2667 <br />C. Describe method to be usO for decontamination: <br />On File at PI15/li11) <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />Way, Lodi, CA to await pick up by a qualiried collection company <br />e. Rlnsale Ilauler and permitted Treatment, Storage & Disposal Facility: <br />Ilauler Name Same as 11 6 Hauler Registration #_ <br />Address City Zip <br />Phone No. <br />000012884 <br />Permitted Disposal Site Refineries Services Patterson, CA or other approved facility. <br />Page 4 <br />