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1. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YFS NO I 1 <br /> (b) Is the current certificate of workers compensation insurance on file? YES NO I 1 <br /> (c) Does the contractor possess ■ 'hazardous Substance ltemmrai C4MWcatlon'? YES X NO 11 <br /> 2. llas a 'Site Hadth h Safety Platt' for this Job site been submlited? YES P( NO I ] <br /> 3, lint applicant performing removal In The City of Tracy obtained a 'Crtding mud Iicavotiou Permil.11 <br /> NIA 11 YE9 11 NO I I If YES, Permit <br /> 4. list the contractor obtained approval from the local flre department to perforin tank cutiing? NAO YESI 1 NOI 1 <br /> 3. is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES I 1 NO <br /> 6. If tnnk residual exists, Identify transporting hazardous waste hauien <br /> Name Neer-Cat Waste Oil hat:ler•s Hauler Kegistraillon t# Cru 9£324 17255 <br /> Address P.O. Box 645 City Dena ir, CA ZIP 95316 <br /> Phone * 1 209 - -_1 332-8,110 <br /> 7. Decoutaraalnatlon Procedat�ex <br /> a. Will tanks) and piping be decontaminated prior to removal? YE9 � NO I 1 <br /> b. Identify contractor performhtg decontaminatlont <br /> Name Jim 'Thorpe Oil , Inc./ DBA H.ich-Marl, CoirstrucLlorr <br /> Address 351 N. lteclatrar r Rd./ P.O. Box 357 City Lod I ,CA ZIP 95241-0357 <br /> Phone No. 20(y 462-45131 y1.0/11h1C: Ilaz M,�l: . hauler # 2667 <br /> C. Describe method o be us d for deconlaiminationt <br /> Ort file aL 'IIS/E117..) <br /> d. Describe how rhtsele material will be stored onsite prior to manirestiig ofrshet <br /> The r•iuseal-e wi,I l_I?ti'QttK2yQ(j by J' tt Thal•ue Oil. Inc, uet•sonel and placed in <br /> (hums- The drums wiIl_be -artslg2i;Lecl_hy,usto out- Yard at BOYBlack Diamond <br /> Way, Lodi, CA to await pick up by a qualified collect ion coinpany.. EPA #CAL 000012bB4 <br /> e. I ansate Hauler and permitted Treatment, Storage do Disposal Facility: <br /> llauler Name Sante as n 6 Daimler Registration <br /> Address City ZIP <br /> Phone No. ( ) <br /> Permitted I)Isposnl Site Hefiueries Services PaLLersott CA or other approved facility. <br /> Page 4 <br />