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(a) Is there a PIIS-EIID contractor's questionnaire on rite or enclosed? YES [ ] NO [� <br /> (b) Is the current certificate of worker's compensation insurance on tile? YES NO [ ] <br /> (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [vl- NO [ I <br /> 2. IIas a "Site Health & Safety Plan" for this job site been submitted? YES ["J NO [ I <br /> 3. Has app cant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit"? <br /> N/A [ T YES [ ] NO [ ] If YES, Permit # <br /> 4. IIas the contractor obtained approval from the local fire department to perform tank cutting? NA[y"YES[ ] NO[ ] <br /> I-- <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/oriping? (If yes, please explain) YES [-Y NO [ ] <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: /��f='> I .c'vVi- r+ f4 `Ntif/.y_T(n?J <br /> Name ' /-{- Hauler Registration # <br /> Address City Zip <br /> Phone # ( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) an 'piping be decontaminated prior to removal? YES NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name` =lC'A-=:c` v= '.[[cr- -�c/1—C c,�� <br /> Address's �'c ar, ( '(141 i- ��,r - City`>7�,�.. [ :T�i.2� Zip .l s--o.� <br /> Phone No.( <br /> C. Describe method to be used for decontamination: <br /> 1. ,t�C;' ,r=ci":->A•E= .'Z'� 'i'!'1.:� 'f'-' !c)/�l'a <br /> RIK,'r-) 4,.0 IW-f ECq ��l/�> Fj/J li / G-L Vh4<� l >t%/.<' �F-7r <br /> d. Describe.ltow rinsate materjal will be stored onsite Mi or to manifesting offsite: <br /> �fo2 _/-YF= ' ix)IA` /lf' <br /> e. Rinsate I3auler and permitted Treatment, Storage & Disposal Facility: <br /> IIauler Namel;—�'tjJ t!r e v I Ce. ' - auler Registration # � <br /> Address �> , �i S city JllJ Zip�tS <br /> Phone No. ( ��`7' ) j2 '(o �4r2 <br /> Permitted Disposal Site C A'I LW/`(�-ZL ( TV U6EL 726eG 151/C..11/I�eg <br /> Page 4 <br /> c 5 v <br /> � ) �I <br />