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1. (a) Is there a PDS-EIID contractor's questionnaire on file or enclosed? YES NO ( 1 <br />(b) Is the current certificate of worker's compensation insurance on rile? YES NO [ ] <br />(c) Does the contractor possess a 'hazardous Snbalanm Removal Certification'? YES NO [ ] <br />2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES NO [ ] <br />J. Has applicant performing removal In the City of Tracy obtained a 'Grading and Excavation PermiP? <br />N/A pQ YES ( 1 NO [ 1 if YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAkYES[ ] NO[ 1 <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO -1 <br />6. <br />7 <br />If tank residual ex]sts, Identify transporting hazardous waste hauler <br />Nor -Cal Waste Oil haulers <br />Address <br />P.O. <br />Box <br />645 <br />P.O. Box <br />357City <br />Lodi ,CA ZIP 95241-0357 <br />Phone # ( <br />209 <br />) <br />332-8710 <br />_ hauler Registration # CAD 982417255 <br />City Denair, CA Zip 95316 <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />Name <br />Jim Thorpe Oil, Inc./ DBA Bich -Mart Construction <br />YES K NOH <br />] <br />Address 351 <br />N. <br />Beckman <br />Rd./ <br />P.O. Box <br />357City <br />Lodi ,CA ZIP 95241-0357 <br />Phone No.( <br />209 <br />_ ) 462-4581 <br />J'1'O/IiMC <br />Baz <br />Mat. hauler 11 2667 <br />C. Describe method to be used for decontamination: <br />On File at PNS/EBD <br />d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br />ll rinspat.p. wi I I be. { by Jim Thorue Oil Inc personel and placed i <br />d ^ ':'t. d will be transported by US to our yard at 807 Black Diamon <br />Way, Lodi, CA to await pick up by a qualified collection company. EPA TICAL <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Same as 11 6 Hauler Registration # <br />Address City Zip <br />Phone No. <br />000012884 <br />Permitted Disposal Site Refineries Services Patterson CA or other approved facility. <br />Page 4 <br />