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1. Is there a contractor's questionnaire on file? c NA [ ] YES NO [ ] <br /> a) Is the questionnaire enclosed? U-),) YES [ ] NO ( ] <br /> b) Is the current certificate of worker's compensation insurance on file? YES (yj/ NO [ ] <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [ j NO [ ] <br /> Z Has a "Site Health & Safety Plan" for this job site been submitted? YES WINO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [vj-*,� 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 /> W&U T ",wy L To H # li 6gkpY Qs> <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO(-4 ^ <br /> 7. Decontamination Procedures: <br /> a. Identify h=r=econtamination <br /> Name — <br /> Address P.O. 183(. City San Lean" Zip 577 <br /> Phone No. 51( O ) 51a-5511 <br /> b. Will tank(s) and piping be decontaminated? YES [ ] NO [ ] <br /> C. Describe method used to clean tank(s) and/or g[ping (If nor in concracto s file): <br /> r/te 4PAL-s arod_._p1d�f29 will (� hvp�e Nnserl t3:�L,wa�er <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite:Pw1 I <br /> nt <br /> —Ae. riinsedt uijl[ be s�cledin fI�'�unk9 and %6-11( be. +�Aer� otct io <br /> 4A,, f-ea)ovul i -flue fLscensed t sfe h er <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardppus Waste Hauler <br /> Name � J�1� C�11C2 <br /> Address �1 ) tn)Q c in <br /> City State cP Zip q L; I O_) <br /> Phone No. (L( ( K )` Hauler Re;istration # r,nc�# <br /> QA Tb 'd' CPD Ob471116� <br /> Page 4 <br />