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d <br /> ' ( J � <br /> I, h there a contractor's questlonnalre on file? NA YES NO <br /> E YES } J NO <br /> a) is the questionnaire enclosed? <br /> h) Is the current certificate of worker's compensation insurance on file? <br /> YES �� NO [ [ <br /> C) Does contractor possess a 'I lazardous Substance Removal Actions Cert.'? NA [ } YES J)q NO [ J <br /> - ° S <br /> 2. Hes A 'Silo Health & Safety P1ati for this job site been subrultted? YEF] NO <br /> [ ] <br /> a) USA underground utilities will be notified prior to excavation. <br /> 3 ,as applicant performing removal in the City of Tracy obtained a "Grading and kxcuvutfun I eruill'? <br /> NIA It YES [ ] NO [ ] if YES, Permit # <br /> YES I) NO [ } <br /> 4. Have tank(s) or piping pending removal leaked in Itte past? Uril<nQwn <br /> 5, What will be the disposit'Ion of the tanks)/piping? 04 iii he tiWe riitsec} anti d a osed of <br /> 6. Ilas the contractor obtained approval from the local fire department to perform tank cutting? NAJ ] YES}XJ NO} ] <br /> 7. Decontamination Procedures: <br /> a, Identify COntraClor perfonning decontamination <br /> Name Jim ThorpIE,1e Oil Irtc. d.b.a. Rich- Mart Constructiatt <br /> Address <br /> ec tnan po. X. City o 1 Zil, <br /> Phone <br /> b, Will lank(s) and piping be decontaminated? <br /> YES Jx} NO ( J <br /> C. Describe method used to clean tank(s) and/or ppiping (if not in contractoes tile): <br /> The tank (s) and associated pip 119 will be tt il�l'I r•iitsed on site by <br /> onc"o"ins-1--s-i reg <br /> tji <br /> s eanin <br /> rinses wt s gam or o wa er. insa a 1:14111:1561111e is on ' i e to your t7 1C@. <br /> d, Describe how Ansate material will be stored on site prior to manifesting offsite: t-- <br /> �nr .. t►,o raitik f g1 h <br /> 11as3te-1�t111 t inri ki11t11]a[':.-266 - -- <br /> ls <br /> g, State Regisiered Hazardous Waste Haulers and 17er1111tied Disposal Facilities. <br /> a, Resldual/llazardouOWaste Bate oil ule s <br /> uf <br /> Name o Cal <br /> Address o Il Stale�— Zip <br /> City Dena r Ca• 6 lluttier Registrullou' #CAD 902111 255 <br /> Phone No. 1300 332-B7 10 33 <br /> b, Eventual disposal ofo�iothereapProbedRdisposal facility13331 N. Hwy. <br /> Paterson, Ca. 95363 Page <br />