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(a) Is there aPHS-EHD contractor's questionnaire on file or enclosed? <br /> YES NO ( ] <br /> (b) Is the current certificate of worker's compensation insurance on filet <br /> YES JJkJ NO [ I <br /> (c) Does the contractor possess a 'Haxardons Substance Removal Certification" YES 4' NO [ ] <br /> Has a Site Health & Safety Plan' for this Job site been submitted? YES NO [ I <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading <br /> and Excavation Permit? <br /> NlA>GI YES 17 NO [ 7 If YES, Peewit # <br /> 4. Has the contractor obtained approval from the local rue department to perform tank cutting? NA[x YES[ ] NO( ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Hader Registration #--j2 <br /> Name <br /> Address 22g }'�artr V31✓d• City 1�" <br /> Zip �iAH %o <br /> Phone # ( filo 235 — 1393 <br /> +. Decontamination Procedur= <br /> a, Will tank(s) and piping be decontaminated prior to removal? YES NO [ ] <br /> b, Identify contractor performing decontamination: <br /> Name FE r l^a-' <br /> 1✓d• City t2��--J Zip ci' 1Kot <br /> Address 256 1`� �r'r — <br /> Phone No.( � <br /> C. Describe method to be used for decontamination: <br /> _ d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> V <br /> e, Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> 1 r,L• Hauler Registration <br /> Hauler Name ��LJLsa <br /> Address `ZSR Parr <br /> (31✓d . _ City12,x_^=1 Zip fA <br /> Phone No. <br /> Permitted Disposal Sitee— <br /> Page 4 <br />