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1. Is there a contractor's questionnaire on file? NA [ ] YES NO [ ] <br /> a) Is the questionnaire enclosed? YES [ ] NO'(>d <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 X NO ( ] <br /> 2. Has a "Site Health 8r Safety Plan" for this job site been submitted? YES PJ NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A t( YES [ ] NO ( ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? YES [ ] NO [ ] <br /> Unknown <br /> 5. What will be the disposition of the tank(s)/piping? <br /> Tank(s) and piping will be triple rinsed and disposed of as scrap. <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YESD4 NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name Jim Thorpe Oil, Inc./ Rich-Mart Construction <br /> Address P-0- Rx 'I5'/ City Lodi Zip 95241-0357 <br /> Phone No.(2()9 ) 462-4581 <br /> b. Will tank(s) and piping be decontaminated? YES NO [ ] <br /> c. Describe method used to clean tank(s) and/or piping (if not in contractor's file): <br /> On file <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> Rinseate will be removed from the tank(s) by Jim Thorpe Oi1,Inc. oersonel , <br /> placed in drums and transported by same to our yard at 807 Black Diamond Way <br /> Lodi Ca. , to await pickup by waste oil collection company. <br /> J'I'O/RMC Haz Mat hauler # 2667 EPA site 11 CAL 000012884 <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name Nor-Cal Oil Waste Oil haulers <br /> Address P.O. Bx. 645 <br /> City Denair, State Ca. Zip 95316 <br /> Phone No. 209 ) 332-8710 Hauler Registration # CAD 982417255 <br /> Page 4 <br />