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r. <br /> 1. Is there a contractor's questionnaire on file? NA K YES [ ] NO [� <br /> a) Is the questionnaire enclosed? YES [ ] NO [ ] <br /> b) Is the current certificate of worker's compensation insurance on file? YES [ ] NO [ ] <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NAS(] YES [ ] NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ ] NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A Pq YES [ ] NO [ ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES [ ] NO <br /> 5. What will be the disposition of the tank(s)/pipin^g?/ <br /> 27 /Ywlnndircre/W <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NAS'(YES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor perfor�ming deco tanmination <br /> Name /iY )y (/hy Lp t/�q f.�� <br /> Address 2 20 City 'Ll Zip 9 /O 7 <br /> Phone No.( 'Alf -57-Y2- 41'93,L <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 contractor's file): <br /> d. Describe how rite material will be stored on site prior to manifesting offsite: <br /> o IA <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/H rdou Waste Hauler <br /> Name H <br /> 1 <br /> Address 2 <br /> City State Zip 96 f/ O 7 <br /> Phone No. /S ) SA3- -Jt 9 3 S Hauler Registration # <br /> Disposal Site <br /> Page 4 <br />