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contractor's questlonnalre on rile or enclosed? <br /> Yr-,S [A NO [ ] <br /> 1. (a) Is there a PIIS-EHD cont <br /> (b) Is the current certificate of worker's compensation Insurance on file? NO [ ] <br /> YES [� <br /> (c) Does the contractor possess a 'IIarardous Substance Remand CertilSattion? YES NO [ ] <br /> job site been submitted? YES Ed NO [ ] <br /> Z, Has e site Hearth &Safety Place' for this] <br /> 3, Has applicant performing reov n the City of Tracy obtained a 'Grading and Excavation Permit? <br /> N/A pt] YES [ ] [ I <br /> U YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NApt] YES[ ] NO[ ] <br /> g, Is there knowledge or evidence or leakage from the tank(s) and/or piping? (Ir yes, please explain) YES [ ] NO Irl <br /> 6. If tank residual exisLs, Identify transporting hazardous waste hauler. <br /> Name Rich Hamelton Trucking IIaulerRegistration # 2753 <br /> Address 1217 So. 7th Street City Modesto Zip 95351 <br /> Phone # ( 209 ) 524-9653 <br /> 7. Decontamination Procedures <br /> a. WiH tank(s) and piping be decontaminated prior to removal? YFS NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name SEMCO <br /> Address 1217 South 7th Street City Modesto Zip 95351 <br /> Phone No.( 209 524-9653 <br /> C. Describe method to be used for decontamination: <br /> All residual liquids shall be drained. The exterior shall be <br /> washed using a high pressure water stream. The UST .interior <br /> shall be triple rinsed cleaned in accordance with API 1604 . <br /> d. Describe how Hassle material w 111 be stored onsite prior to manifesting offslle: <br /> Rinsate material shall be stored in 55-gallon drums marked <br /> and dated. <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Allied Peteroleum <br /> _ti „___, � m-.. ,. 2753 <br /> Hauler Name �-^-^-�^---==-------'�- Hauter Registration # <br /> Address 1217 So. 7th Street City Modesto Zlp 95351 <br /> Phone No. ( 209 1 524-9653 <br /> Permitted Disposal Site Allied Peteroleum <br /> Page 4 <br />