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i. (a) Is there a PHS-Econtractor's questionnaire on file or enclosed? YES NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES <br /> 1?C1 NO <br /> (c) Does the contractor possess a hazardous Substance Removal Certification'? YES NO [ I <br /> 2. Has a 'Site Health & Safety Plan'for this job site been submitted? YES A NOKV <br /> [ I <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation permit'? <br /> NIA YU <br /> YES [ ] NO [ If YES, Permit # <br /> 4. Has the contractor obtained approval from the Iocal fire department to perform tank cutting? NARI YES[ ] NO[ I <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If Yes, please explain) YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name ALL/�W 1�E7ADL�t-U�7�I Hauler Regist tiott # 115-0 <br /> Address f'O. f 9.5 City /�bDEST� Zi 9 3�2 <br /> p <br /> Phone # ( 2�� 5 gspp <br /> ?. Decontamination Procedures-- <br /> a. <br /> rocedures;a. Will tank(s) and piping be decontaminated prior to removal? YES NO [ I <br /> b. Identify contractor performing decontamination: <br /> Name -�5E1VG0 <br /> Address 3�'$/ 4/, ,M,9741'.,' City Zip <br /> Phone No. 2C _ 01a <br /> c. Descn'be method to be used for decontamination: <br /> T7tF %,"�yo'S ,g v,) <br /> IiOLLI/i!E f//6!fTffE L/.P T � l VN EXCteDE TttE GasS� <br /> -4 '6/ 2AI3L-9)at—g f� .G/T. 7iSolE F/VA4-ofl*NSr 5 Cr/![L e-4e.-I-W Ct/*T�� <br /> d. Describe how rinsate material will be stared onsite prior to manifesting offsite: <br /> 5e/- m�rx ,"fy. ilz& 3E sT,ew a v s nr /* At:r /?,E 675- <br /> e/- <br /> Rinsate Hauler and permitted Treatment, Storage &Disposal Facility: <br /> Hauler Name AZZ-1&A AZ7MOLIE /1*W, Hanler Registration # 1/5-8 <br /> Address , City ZVMF15,b zip 953.52 <br /> Phone No. Z?©� ¢qS-ep <br /> Permitted Disposal Site eE.4.-.v1aPv SE.fPlca5 lryTTEE'5,w, e*. <br /> Page 4 <br />