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1. (a) Is there a PUS -FUD contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation Insurance on tile? <br />(c) Does the contractor possess a 'Hazardous Substance Removal Certification'? <br />2. Has a 'Site Health & Safety Plan' for this job site been submitted? <br />YES CQ NO [ I <br />YES W NO I 1 <br />YES HCl NO [ ] <br />YES bc1 NO [ ] <br />3. Has applicant performing removal in the city of Tracy obtained a 'Grading and Excavation Permit`? <br />N/A W YES [ ] NO [ I If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAt4 YFS[ ] NO[ ] <br />S. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES I ] NO M <br />6. If tank residual exists, Identify, transporting hazardous waste hauler. <br />Name RAM'S N V I RON M r nL l /,l_ 5 R V I OE5 Hauler Registration # CA D 4400 3 5 �h <br />Address P.O. 13ox 401 city W. SAC. zip X1.5691 <br />Phone #ci( 16, ) 3"71 - 2570 <br />7. Decontamination Procedures <br />a. 8911 tank(s) and piping be decontaminated prior to removal? YES TA NO I ] <br />b. Identify contractor performing decontamination: <br />Name WE�7E12f� I�/1F i 12 `�t2yrCE F INC. <br />Address 2735 TEEPEE. bP,. #E city STOCKiON zip 9-'i 205 <br />Phone No.( 209 ) q48 — 6I 24 <br />C. Describe method to be used for decontamination: <br />RIPb� ,FIti1-Sl� WITH WATeR AN() OF- TEQC�eNy <br />d. Describe how Hassle material will be stored onsite prior to manifesting offsite: <br />I N >5 GALL0N DRUMS <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler NamekAMOS ENVEOMMENTAL Hauler Regi tratlou *f AD 44X <br />Address 20. Box 401 city VJ. SAC zip X16691 <br />Phone rJo. ( Q /6 ) 371-2570 <br />Permitted Disposal Site C 1 IL e- kF7-1 C 4 7 5 f 7�oR— 1.31 <br />J EDWCOD CI% VI CA 940(,3 - (415) SL -8 5! 1 <br />Page 4 <br />