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(a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES NO [ ] <br /> 2 Has a 'Site Health&Safety Plan'for this job site been submitted? YES NO [ ] <br /> 3. H nt performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> NlYES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NOX <br /> 6. If tank residual sexists, identify transporting hazardous waste hauler: 5 TM �� OO 25 <br /> Name ( `C2����� ��c12�mN NG Hauler Registration# A 1- 55Z�5 <br /> Address ��t�D M�1.1 11` �l— City 0ALLW Zip94-G21 <br /> Phone # ( S�0 X33 -033(5; <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES/X— <br /> ES NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name CK05 E Y 4 OIOLEZIJ 4J <br /> Address 84130 AlYlel (Az aet;--r City DAX� Zip 6 40 2 <br /> Phone No.( 510 (0 3- <br /> C. Describe method to be used for decontamination: <br /> SLE IZIt�5C GNC) 0P,Y I C� <br /> d. Describe how riin'}s�attee material wiilll� 1e stored onsite prior to manifesting offsiitte: ` I�) T <br /> MkMiFeJI'GL l J -y� � AIV A fZo\JU-� 1 S;, [), <br /> e. Rinsate Hauler and permitted Treatment, Storage klL15 <br /> lI& Disposal Facility: 5r �- - HOK� * 0025 <br /> Hauler Named �C.(L�VIV )NC,,, Hauler Regist�'1�n' PMWO '35Z35 <br /> Address R Z("�30 SUzgi� City OAKIA I b Zip 9462-1 <br /> Phone No. (^, 10 <br /> Permitted Disposal Site 01 1 G <br /> Page 4 <br />