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1. Is there a contractor's questionnaire on file? NA [] YES M--*INO [ ] <br /> a) Is the questionnaire enclosed? YES [ ] NO [V <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 [b]�NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [q' 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 /> V15PoStTioN 0 T nJK N Pally(n www 6t57 <br /> L F-V IA) k? gay c>v, rc%f Gyv <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[krYES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name SEM CO <br /> Address eM W, CityZip <br /> Phone No. O 67-y- 9695'R <br /> b. Will tank(s) and piping be decontaminated? YES [V]' NO [] <br /> Q Describe method used to clean tank(s) and(or piping (If not in contractor's file): <br /> T6lE TIA/K AND ASSCeVr d) /�1 6 k tcL tli~ 772,c'P — /264/SE"/> AV /"b <br /> —7;YP Ges-r 2/.vSE kJac CaifN TEAM cLtgar Gy/FTE2 ✓D p�/� <br /> Dee6 LAD[ ,4F,yE DETtel,604)7- brbU-0 -1& T3�f TctlO GG�ia t/ !r/�4TcGL <br /> Re/vSEe, <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> E "V5 i= /"47-Ee!' L 6t//LG S /LED Ort/ G(TE IAI 0,O, <br /> � QVC=Q t)5- <br /> 8. <br /> S8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name 41, L CU <br /> Address , 02 <br /> City Id—me State Zi IM <br /> Phone No. ( `LD9 ) — g $DO Hauler Registration <br /> J U L 2 9 ?991 <br /> Page 4 ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br />