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1. Is there a contractor's questionnaire on tile? <br /> NA [ ] YES>f NO <br /> YES t NO <br /> a) IS the questionnaire enclosed? <br /> YES X NO <br /> b) Is the current certificate of worker's compensation insurance on file? ( ] <br /> C) Does contractor possess a 'Hazardous Substance Removal Actions Cert.'? NA ( ] YESX NO ( ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? <br /> YES ,' NO ( j <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit"? <br /> N/AjK YES ( ) NO ( ) If YES, Permit # <br /> YES NO <br /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) ( ] [ ] <br /> 5. What will be the disposition of the tanks)/piping? <br /> 'Tank(s) and piping will be triple rinsed and disposed of as scrap. <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA( j YE3^"NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name Jim 'Thorpe Oil, Inc. / Rich-Mart Construction <br /> Address P.U. Bx. 35'l Ctty Lodi zip Q5241-0357 <br /> Phone No. 2U 8- 1 <br /> b. Will tank(s) and piping be decontaminated? YES NO ( ) <br /> C. Describe method used to clean tank(s) and/or piping (if not in contractor's file): <br /> On rile. <br /> V <br /> d. Desribe how rinsate material will be stored on site prior to manifesting offsite: <br /> R t nsPateWj]1 hP re Frnrn t ha tank C s) by 1T(l/RMf'�� <br /> by <br /> J <br /> waste <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name Nor-Cal Oil Waste Oil haulers <br /> Address P.O, Bx.645 <br /> City Uenair. State Ca. Trp 95316 <br /> Phone No. (_8UO ) 3:32-8710 Hauler Registration # CAD 982417255 <br /> Disposal Site Ref fineries services Patterson, Ca or other aoved facility. <br /> W <br /> Page 4 <br />