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(a) Is there a PIIS-EIID contractor's quesilonnalre an file or enclosed? YESN NU [ [ <br /> (b) Is line current certificate of worker's compensation insurance on Elie? YES' N0 [ [ <br /> (c) I)oes the canlraclor possess a 'Hizardoux Substaum Removal C mtMcailon`? YES X NO I 1 <br /> 2. Has a 'Site I1e3lit6 & Safdy IPtsn' for this job site been subuthW? YES pf 11011 <br /> 3. 1Ins applicant performing femoral to the Cil? of I racy obtained a 'grading and Excavation Permit`? <br /> NIA rI YES [ I NO [ I If YES, Permit <br /> 4. Iles like contractor obtained approval from lite local fire department to peeform lank cuitlag? NAKYESI j NO <br /> S. is theme knowledge or evidence of leakage from the lank(s) and/or piping? (if res, please explain) Y13S I ) NO <br /> 6. If tank residual exists, Identify transporting hsxsrdous waste haulers <br /> Name Nor-Cal. Waste Oil hatil ei s llauler Registration 0 CAI) 9©24 17255 <br /> Address P 0 Ikix 645 City Denah',r, CA Zip 95316 <br /> Phone * ( 209 } 3.3.P-ll1 10 <br /> Decontamination Ptivicedure= <br /> a. Will lank(s) and piping be decontaminated prior to removal? Y" R NO I 1 <br /> b Identify contractor performing decoulaminallont <br /> Name Jiun 'llitnrpe 0110 Inc./ DI1A liitln-Karl. lonnstvii( LIoin <br /> Address 351 N IfeLl<u1.stn Ilcl / P.0 ll(-)x 351 Cit, i-rxll ,CA ZIP 95241-035'1 <br /> Phone No L 209 } 462-1601 ,!If)/TIMI; Ilaz Mil, hauler U 2667 <br /> C. Describe method o be for deconlaminatloni <br /> Uii file al. ), <br /> IS/�1II) <br /> d. Describe how rinsale material will be stored onslle prior to manlfesiing aRsltes <br /> U 111f,, pet,soiiel and placed lei <br /> 1lut7tls- 111e fl o out aid al, 1301 l I ALk Dlau►ornd <br /> Way, Lodi, CA W awa i 1, 1)1(.I< tip by a clua 1 i f l eel (t)] lec.l,ion couipai ny. EPA VAL 0000 121104 <br /> e. Rhnsate llauler end permuted frealmeeti, Slorage & Disposal Pacllllys <br /> Hauler Name Saute as 0 6 llauler Registration 0 <br /> Address City Zip <br /> Phone No ( <br /> Permitted Disposal Site Ne[merles Serwlc.es PaUea son CA or ol.lier approved faclI 1Ly. <br /> Page 4 <br /> I <br />