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1. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YES)Q NO I I <br /> (b) Is the current cerllOule of workeem compensation Insumum on Ole? YES NO I I <br /> (c) Does the contractor possess a 'llaandous Subelanoa Reasoval Certtilation`f YES No 1 I <br /> 2. Ilse • 'Sale Ilalth 6 Safely Phm'for this Job site been submlltcd? YES rq NO 1 I <br /> J. Iles appllcanl performing removal In the City of'Tracy obtained a 'Grading and Excavation 1'ermll'? <br /> N/A rl YES 1 1 NO 1 1 If YES, Permll N <br /> 4. Iles the conlaclor obtained approval from line local Ore department to perform lank culling? NAAYESI I NO, <br /> S. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please expluln) YES I I NON <br /> 6. If lank residual exists, Identify transporting hamrdous waste haulen . <br /> Name Nor-Cal Wasl.e Oi 1 haulers Ilauler Registration 0 CAI) 982417255 <br /> Address 11.0. Box 645 City Denalr, CA Zip 95716 <br /> phone M ( 209 ) 732-07 10 <br /> 7. Decontamination rrecedur <br /> a. Will lank(s) and piping be deconlaminsded prior to removal? YES NO I I <br /> b. Identify contractor performing decontaminations <br /> Name Min Thorpe Oil , laic./ NBA 1110h-Marl, C0llsLru(.Llon <br /> Address 751 N. Beclunasi itd./ P.O. Box 357 City i.(xII ,CA Zip 95241-0157 <br /> Phone No.( 209 ) 462-45131 ,1'111/ 1MC Ilaz. Mal . hauler N 2667 <br /> C. Describe melhod o be for deconlamtnallont <br /> Os Pile al, �'lIS/-PII) <br /> d. Describe how rinsate material will be stored onsite prior to manlfeslhrg oRsllen <br /> The r•Inseal.e will be renxwed by .aim '?borne 011, 111c. uel•sonel said placed LI <br /> pintas_ The drvsns wi 1 I be Lr-nis001•Led by us Lo our vaud al, 00'1 Black Dlauxwd <br /> Way, L(xli, CA Lo await pick up by it qualified collecLlou c(xnpauy. EPA VAL 000012111111 <br /> e. Ithnsale Ilauler and pamllled 'I'realmenl, Storage 6 Disposal Facility% <br /> Ilauler Name Same as p 6 Hauler Registration <br /> Address Cloy Zip <br /> 1'Inmte <br /> Permitted Disposal Site Nefiuerles Services PaLLersou, CA or oLher approved faciI ILy. <br /> rage 4 <br />