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1. (a) Is there a PHS-EIID contractors questionnaire on file or enclosed? YES ( NO [ <br /> i <br /> (b) Is the current certificate of worker's compensation insurance on rile? ITS I NO [ ] <br /> (c) Does the contractor possess a 'IIazardous Substance Removal Certification"? YES [ J 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 ( ] YES [ ] NO [ ) If YES, Permit # <br /> USv4Ntrep -pn-FL'to C�ee.(e— -t�lzo <br /> 4. Has the contractor obtained approval from the local fire depart ens to perform tank cutting? NA[ ] YES[ ] NO[ ] <br /> S. Is there knowledge or evidence of leakage from the tnnk(s) and/or piping? (If yes, please explain) YES ( ] NO [ ] <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name ERlUeso/�( / f�G, Hauler Registration # 00/Y <br /> Address 755 CA RR of VV City R/Cf 1ko1V-0 Zip <br /> Phone # ( 5 (U ) 235' 139'3 <br /> 7. Decontamination Procedures: \ - <br /> a. Will tnnk(s) and piping be decontaminated prior to removal? YES [ ] NO p7 <br /> b. Identify contractor performing decontamination: / <br /> Name A/A <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to✓manifesting offsite: <br /> WILL. 6C— LEST i.1J Odr— <br /> A ER/CKSOa, <br /> C. Rinsate hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name C—Rfcl- OGo " IIauler Registration # 00 <br /> Address 255 PA-IiR �trVV City T\lCftM0&b Zip `IyBoI <br /> Phone No. ( .5 <br /> Permitted Disposal Site / oMce f1�oiJwt��JL <br /> Page 4 <br />