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1. Is there a contractor's questionnaire on file? NA [ ] YES [t,]�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 /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [YJ1NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [v' 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 tank(s)/piping? , <br /> A <br /> jJ / <br /> r I'ti L CQ4 L rb dD �414 Sr /Gvyl/,7 r <br /> b. Has the contractor obtained approval from the local fixe department to perform tank cutting? NA[ ] YES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name <br /> Address GF/ P— City / E570 Zip 2SL,3$1 <br /> Phone No.(-- Op--) 52 -Q�G-a3__ <br /> b. Will tank(s) and piping be decontaminated? YES [vr NO [ ] <br /> C. Describe method used to clean tank(s) and/or piping (If not in contractor's file):, _ <br /> THE ryk ,�40 101,P1416 &1161. 9C ccr„A-Eb 6, ' iIZrpr� 2aNS%v . , F#E <br /> rI�S 7 &146 6" e7E Gy/77-/- wWT€rz- 4-r 4 7?5"d &7U1Z,E DF..%B!" <br /> AQP &0 oE62,rDeA-Pe-6- Oi irvbeivT,_ 28rs <br /> -a-V -C Lt-R,t/ ;ve7rL2 _las <br /> d. Desc ibe how rinsate material will be stored on site prior to manifesting offsite: <br /> /it/ T�iJ'l 7 2 [_ rvrGL E i4) 5� <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Wase Hauler <br /> Name Al-1,!M r/ZaLE6eln <br /> Address AO,. A? <br /> City - _ 6g E Stv State Zip 3,52 <br /> Phone No. (�_) 57 Hauler Registration # //SB <br /> Page 4 <br />