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I. (a) Is there a PHS-EHD contractor's questionnaire on rile or enclosed? ITS [ ] NO [JJ/ <br /> (b) Is the current certificate of worker's compensation insurance on rile? YES M NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal CertiL©tion`' YES ro" NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES ["] NO [ ] <br /> 3. Has apoWant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit" <br /> N/A M YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[uJ YES[ ] NO[ ] <br /> r__� <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/oripifit ? yes, please explain) YES NO [ ] <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Name Hauler Registration # <br /> Address City Zip <br /> Phone # ( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) a piping be decontaminated prior to removal? YES [-]NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Na mezoJrrcl AL <br /> �/ fBt� �f2' - ` ' <br /> Address��-© /Yn ljtOA)) S -T-. CityTt Zip <br /> Phone No.( O BR ) W�q— X 'S 7,3 <br /> C. Describe method to be used for decontamination: <br /> 14 <br /> o ,, s &. "A FA c ter, <br /> d. Describe.) qww nnsate ma `al will be stored onsite prior to manifesting offsite: <br /> IwT� � C F�sdziAE,ATE <br /> W1,46 Al r.iLbanE l��t)Ei <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Namel� t y e o Hauler Registration # � <br /> Address/333 , /- �/ .� City �;SIJ Zip Cr <br /> Phone No. ( � )!!�2 - C ?If <br /> ` <br /> Permitted Disposal Site A-5, Ala)` TV <br /> Page 4 <br /> 0 0 <br />