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• <br /> Is there a contractor's questionnaire on file? NA ( ] =It 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 /> ? Has a "Site Health & Safety Plan" for this gob 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 /> 4. Have tank(s) or piping pending removal leaked in the past? YES ( ] NO <br /> 5. What will be the disposition of the tanks)/piping? <br /> Will <br /> 6. Has the contractor obtained approval from the local fore department to pertor7t tank cutting? :tiA[ YESI ' NO[X] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name <br /> g -171 1 <br /> Address 1 W ('rnMT.7Pj 1 Av !11 C13 C1N Zip <br /> Phone No.( 7 p g ) g n o S <br /> b. Will tanks) and piping be decontaminated? YES (X] NO ] } <br /> C. Describe method used to clean tanks) and/or piping (Is lot in cont v~c.o1 's 71e): <br /> Tanks and <br /> contractor is on- f ' <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> Tanks will not be rinsed , hauled hazardous . <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name Exi ,�kp9ti , IRE . <br /> Address <br /> City F e 5 n State Zip 937 1 1 <br /> Phone No. L2 0 - 4 5 2-9 0 0 5 Hauler Registration M- 0 19 <br /> Page 4 <br />