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1. Is there a contractor's questionnaire on file? NA [ ] YES K] NO [] <br /> a) Is the questionnaila enclosed? YES [ ] NO [}� <br /> b) Is the current certificate of worker's compensation insurance on file? YES (X] NO [ ] <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [ ] NO <br /> 2. Has a "Site Health & Surety Plan" for this job site been submitted? YES [xJ NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A)4 YES [ ] NO [ ] If YES, Permit # <br /> 4. Have tank(s) or pi ing pending removal leaked in the past? YES [ ] NO [] <br /> SKI cr L-OA <br /> 5. What will be the disposition of the tank(s)/piping? <br /> Tank( s ) and all plumhing 1 dernnt + rl h P they <br /> e <br /> 17an1 and away fromtl,o city and th will—be be haul ars y from th +fp by <br /> Cal Coast Manufacturing to Cal Coast Manufacturing in Turlock, ca . <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name _ Crisp Construction Co ThIC <br /> Address _p,0, Box 1066 City Visalia Zip 93277 <br /> Phone No.( 209 )734-6381 OR ( 209)931 _18 <br /> b. Will tank(s) and piping be decontaminated? YES [}(] NO [ ] <br /> C. Describe method used to clean tank(s) and/or piping (If not in contractors rile): <br /> Tank(s ) will ha tripple tins^-' with .a high pressure washer and <br /> plumhino lines will he tripple rinsed- the m way at theam ime. <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> Refineries Services will purrip rinsate into their vacuum truck <br /> 'itnndediately aftgrtank(s ) and plumbing lines are trilople rinsed . <br /> Rinsatg will be haulers to the disposal site of Refineries Services ' <br /> disposal site , <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. ResiduaVHazardous Waste Hauler <br /> Name Refineries Services <br /> Address P .O. Box 1 167 <br /> City Patterson State CA. Zip 95363 <br /> Phone No. 800 874-4444 Hauler Registration #CAD083166728* <br /> Page 4 <br />