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is there PHS-EHD contracto?s auestionnaire on rile or enclosed? YES [A] -NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES WINO [ ] <br /> (c) Does the contractor possess a 'Haacdoos Substance Removal Certification': YES t K NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES (y---'NO ( ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and 5=vation Permit'^ <br /> N/A [ ] YES ILK NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAPT'�ES[ ] NO[ ] <br /> _. 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 hazardous waste hauler. 9Name��C G� n _Hauler Registration #in0/ <br /> Address �0.222_ � City` Zip <br /> Phone # <br /> 7. Decontamination Procedures: '',/ <br /> a. Will tank(s) and piping he decontaminated prior to removal? YES ( ] NO F- <br /> b. Identify contractor performing decontamination: <br /> Name A) ZA <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> 1A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting, offsite: <br /> e. Finsate Haulersnd permitted reatment_Storage &.Disposal Facility: <br /> Hauler Name 6ZL -k!& r, fRlaola Registration # QG (C1 <br /> .address � 5 � �A6zp l�It)c� City K:c hYYLnYId Zip 94LEjo / <br /> Phone No. ( rJ 10 <br /> Permitted Disposal <br /> Page 4 <br />