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1. (a) Is there a PIIS-EIiLstractor's questionnaire on rile or enclo* YES P� NO [ I <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES JC] NO [ I <br /> (c) Does the contractor possess a `IIarsrdious Substanm Remus/ CatiGcationo? YES ;k] NO [ ] <br /> 2. Ilas a 'Site Health do Safety Plan' for this job site been submitted? YES W NO [ ] <br /> 3. IIas applicant performing removal In the City of Tracy obtained a 'Grading and Fmcavatlon Permit'? <br /> NIA [Ij YES [ ] NO [ ] If YES, Permit # <br /> 4. Iias the contractor obtained approval from the local fire department to perform tank cutting? NA SCI YES[ ] NO[ <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name FALCON ENERGY Hauler Registration # 2463 <br /> Address P.O. Box 1257 Cit-_ STOCKTON, CA zip 95201 <br /> Phone # ( 209 463 7108 <br /> 7. Decontnmination Pnx=dnres_ <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO I ] <br /> b. Identify contractor performing, decontamination: <br /> Name FALCON ENERGY <br /> Address P.O. Box 1257 city STOCKTON, CA zip 95201 <br /> Phone No. 209 463 7108 <br /> C. scribe method to be used for decontamination: <br /> SING NON HALOGENATED WATER, HIGH PRESSURE WATER AND STEAM, RINSE UNTIL <br /> DECONTAMINATED A <br /> d. cribe how rinsate material will be stored onsite prior to manifestingoffsite: <br /> IM WILL BE VACUUMED INTO TRUCK DURING CLEANING AND RANSPORTED IMMEDIATELY <br /> 10 1,)L)r FOR DISPOSAL THROUGH RECYCLING <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Hauler Registration # ?Q�7 <br /> Address P.O. Box 1257 City STOCKTON,CA zip 95201 <br /> Phone No. ( 209 463 7108 <br /> Permitted Disposal Site G T Rsm FNV T RONMFNTAI , RAKFR�F T FLn, CAL I FORK I A <br /> Page 7 <br />