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• <br /> 1. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? <br /> YES [)I N© [ 1 , <br /> (b) Is the current certificate of worker's compensation insurance on Ole? <br /> YES [SQ NO [ ] <br /> NO <br /> (c) Does the contractor possess a 'IIaar=rd00a Snbslaaa Reutcr+al t"ertiflntiora'? YES ' <br /> [ l <br /> 2. nag a 'Bite Health &Safety Plan' for this job site been submitted? <br /> YFS [x] No [ ] <br /> 3. liar applicant performing removal in the City of Tracy obtained a 'Grading and Fmm"tlon Permit'? <br /> NIA K YES I 1 NO [ ] If YES, Permit # <br /> 4, Ila@ the contractor obtained approval from the local fire department to perform tank cutting? NAPq YES[ I NO( ] <br /> S, l@ there knowledge or evidence of leakage from the tank(g) and/or piping? (If yes, please explain) YES [ ] NO <br /> s Identify transporting hazardous waste haulers <br /> residual exi y po <br /> 6. If tank �r <br /> Name NOR-GA . Oil. Waste oil hauler Hailer Registratloa #CAD 982417255 <br /> Address E.Q. QQX 05 City_ Deriair, Ca. Zip 95316_ <br /> Phone # (, 2Q9._j 332-8710 <br /> 7, Decontamination Proeedoreaa <br /> a. "III tank(s) and piping be decontaminated prior to removal? <br /> YF.3NO <br /> b. Identify contractor performing decontaminations <br /> Name Jim Thorpe Oil, inc./ DBA Rich-Mart Construction <br /> Q524O <br /> Address <br /> 351 N Becktnan Rd. City Lodi. Zip <br /> Phone No. 2( 9 368-6175 / 462-4581 <br /> C. Describe method to be used for decontaminatiant !on. <br /> 'P atna/e wi i i hP 4 r7 is r' ltl, hr�t._�rat n <br /> , <br /> iduals. <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsltet it <br /> Rinsate will be stored in ii ' <br /> e sealed acid labeled until Lullar <br /> e. Rinsate hauler and permitted Treatment, Storage & Disposal Facility$ <br /> Hauler Name No hauler Registration # CAD 282417255 <br /> Address City Denair Zip 95316 <br /> Phone No. (_ 2Q9_—) 332-010 <br /> Permitted Disposal Site Refiner' Patterson Ca. or other facality. <br /> Page 4 <br />