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1. (a) Is there a MEND contractor's and subcontractor' a questionnaire on file or enclosed? YES I� [ I <br />(b) Is the current certificate of worker's compensation Insurance on file? YES [ NO [ [ <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES j;-" NO [ I <br />(d) Has everyone on site, Including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES NO [ J <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [ I NO W.- <br />3. Has appe6t performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />Nikif I I NO I I If YES, Permit M <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA(�J NO[ J <br />5. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES I I NO J/ <br />6. If tank residual exists, Identify transporting hazardous waste hauler. <br />Name%1l ejUe,� V ia>ryx ��v,'r,iJ. Hauler Registration x <br />Address <br />City <br />Phone bD 2i �h YET_ <br />Zip <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES H -"N0 [ I <br />b. Identify contractor performing decontamination: <br />Name/s��4- %�- -e ./ <br />Address g© ��.Ut�v f, 5sf, zip <br />Phone No.( <br />Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onslte crier to manifesting offsite: <br />e. Rhtsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name J`rry&2C6r� Hauler Registration x <br />Address / City Zip <br />Phone No. ( e0Z> 1 7�7 Z --/6 �C <br />Permitted Disposal Site <br />EH 23 046 (Revised 10119198) Page 4 <br />