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(a) Is there a PIIS-EIID coy ' 'actor's questionnaire on file or enclosed. ITS p(] NO ( ] <br /> (b) Is the current certificate of worker's compensation insurance on rile? YES (C] NO [ ] <br /> (c) Does the contractor possess a 'Ilamrdons Substance Removal Certlfiadion'? YES ] NO [ ] <br /> :. <br /> Has a 'Site IIealth & Safety Plan' for this Job site been submitted? YES [ NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and E�=vation Permit'? <br /> N/A [4] YES [ I NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[(] YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please exnloin) YES [ ] NO DO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name FALCON ENERGY hauler Registration # 2463 <br /> Address P,O, Box 1257 City STOCKTON, CA zip 95201 <br /> Phone # ( 209 ) 463 7108 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO ( I <br /> b. Identify contractor perfcrming decontamination: <br /> Name FALCON ENERGY <br /> Address P.O. Box 1257 City STOCKTON, CA zip 95201 <br /> Phone No.( 209 ) 463 7108 <br /> C. 117scribe method to be used for decontamination: <br /> SING NON HALOGENATED WATER, HIGH PRESSURE WATER AND STEAM, RINSE UNTIL <br /> d• J)Q cribe how rinsate material will be stored onsite prior to manifesting offsite: <br /> N]// 4,-WILL BE VACUUMED INTO TRUCK DURING CLEANING AND TRANSPORTED IMMEDIATELY <br /> I U 1>I IF'r'f)T�iSRT <br /> ' ��I VL11VU <br /> e. Rinsate hauler and permitted Treatment, Storage & Disposal Facility: <br /> IIauler Name Fal rani FNFRry Hauler Registration # 74F3 <br /> Address P.0, Box 1257 city STOCKTON,CA zip 95201 <br /> Phone No. ( 209 ) 463 7108 <br /> Permitted Disposal Site gSON FNVIR�NMFNTAI RAKFR4FIF1 P CAI TPORNiA <br /> Page 7 <br />