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1. Is there a contractor's questionnaire on file? NA [ ] YESY NO [ ] <br /> a) Is the questionnaire enclosed? YES [ ] NO <br /> b) Is the current certificate of worker's compensation insurance on file? YES NO [ ] <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [ ] NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A/" YES [ ] NO [ ] If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? (If yes, list tank #) YES ( ] NO)( <br /> 5. What will be the disposition of the tank(s)/piping? A <br /> a sa,►.►a A 1"0" ' <br /> n 4 <br /> di <br /> iti•.+;,�,a . d/ he D f,..b. a .SAC., 741-:57- <br /> 6. <br /> 61„S6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO[ ] <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name _le1e� 1.�+ 04*_te�r Ott'✓✓.it, =)-s e <br /> Address .2_,2-35- TRe#oee p � S,,,'4,,C_ F City S11Vt A 40e Zip QS2DS <br /> Phone No.(2b f) 9y X - 4/z,t?/ <br /> b. Will tank(s) and piping be decontaminated? YES kA NO [ ] <br /> C. Describe method used to clean tank(s) and/or piping (If not in contractor's file): <br /> L ei t <br /> L o <br /> ag- <br /> moo' <br /> d. Describe howinsate material will be stored on site prior to manifestin offsite: <br /> i/15 a C re a ✓�..-+ D <br /> CoctQ_, <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name � �'v�e�u SeJJ s 4g—, <br /> t Address j.✓ <br /> City V_19 AS ON fState Zip <br /> Phone No. &0 ) Hauler Registration # <br /> Disposal Site <br /> Page 4 <br />