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0 <br /> 1. Is there a contractor's questionnaire on file? NA [ ] YES [q] NO [ J <br /> a) Is the questionnaire enclosed? YES [ ] NOK <br /> b) Is the current certificate of worker's compensation insurance on file?- - S [>� NO [t <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [vr NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [tJ� NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [e YES [I NO [ J If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in 1the past? (If yes, list tank #) YES [ ] NOIre- <br /> [t,]� <br /> p <br /> 5. What will be the disposition of the tanks)/piping? <br /> yr-u oy(5-rn To H t H 5HIP I)EV-V(G6 220 CHINA V5AQQ 5PQ FRAlUG5ca, CA <br /> 1 Ci�1 Vl/VV Y <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NAjfYES[ J NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name 6tot,Det3 W E'S'f B U I l,P e V-S <br /> Address P.o, C3ox 12366 City @ge*TW00P Zip 84513 <br /> Phone No.( 415 ) G34 (61!9 e, ,{ <br /> b. Will tank(s) and piping be decontaminated? YES [v1 NO [ ] <br /> c Describe method used to clean tank(s) and/or piping (If not in contractor's file): <br /> 11J GON i1�ALYOJZ�S FIl.6 <br /> d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br /> I.EAI- F(Loofz 9V-UM5 6R- OTlirV- T?-AUsM2fLT&6lrc, CQUINNEIzs> <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name H 4 R 5PIP 56t7MCG- <br /> Address 220 Cf4lUA 13AS(NJ <br /> City sJaN FRANCISCO State GA Zip 9410'1 <br /> Phone No. ( 415 ) 534-- 4835 Hauler Registration # <br /> Disposal Site 2 Zo C 44 I NA 13A51 IJ CA <br /> Page 4 <br />