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1. Is there a contractor's questionnaire on file? NA [ ] YESV 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."? NA [ ] YES NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES-V NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/NJ YES [ ] NO [ ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? YES [ ] NO Jit <br /> 4 <br /> 5. What will be the disposition of the tanks)/piping? �l" <br /> —M k-GIN 1A i'Tc 6tQ�2t Lrx kt\5 vp.S dtL�j Fzo <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YESVNO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> NamentiC <br /> Address 43 i W - NA-rT Isk 1 City 1' UMCIZZ -o Zip <br /> Phone No.( o� ) <br /> b. Will tank(s) and piping be decontaminated? YES)4 NO [ ] <br /> C. Describe method used to clean tank(s) and/or piping (If not in contractor's file): �7 <br /> I AJ P►?cC 1'Kiw5WiTiq 0d-E&i K L'S AhJQ l WeW-T k: i0i7 t,-t ' <br /> �- O ~Fj +� a tj lC <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> 'Pt K( ' 'E. Jv\�l��+f I A.L. t,<.-,c t_L "n E a EEO j uv WYV Y�rEV�x� G <br /> t e-* 1AAZJ '2-Q()1i wN;s�0_� o." s%TF <br /> S. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name f LLJ ' <br /> Address P Q . Cox— L' - <br /> City ik t Lw\AYZ- State CAr Zip 9:Z3%2¢ - <br /> Phone No. ( 201 ) S L3 ?"t t 3 5`77- '4')J2- Hauler Registration # 1166 <br /> Page 4 <br />