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' Is there a contractor's questionnaire on flit? HAI I YES U NO ( [ <br /> +� a) b the questionnaire enclosed? YES [ f NO [ <br /> b) is the current cerilficate of worker's compensation Insurance on Ale? YES 10 NO [ [ <br /> C) Data contractor possess a "llazaidous Substance Removal Acllons Cell `? NA [ [ YES 14 NO [ [ <br /> Z Ilan M 'Spa Ifealth & Sakly Plan" for this job site been submilled? YES FI NO ( � <br /> a) USA underground utilities will be notified prior to excavation. <br /> 3. flas applicant performing removal in the City of Tracy obtained a 'Grading and lixcavalion Pertrdl`? <br /> NIA t YES[ ( NO[ ( If YES, Permit <br /> 4, llave lank(s) or piping pending removal leaked in tie past? , YES 1) NO[ <br /> r� Unknown <br /> S. What will be the disposition of the iank(s)/piplag? <br /> ec ajW 11aUgsedo <br /> d Ilan the conlraclar obtained approval from the local fire department to perform lank cutting? NAI ( YES( No( 1 <br /> Decontamination Procedures: <br /> A. identify conlraclos perfarcning decontamination <br /> Name Jim `boree Oil ftic. d.b.a. Rich- Mart Constructloti <br /> Address35T-71: Heckman lid. po. bx-7351 City .n Zip <br /> Phone No 0 ) <br /> 368-6175 <br /> b. Will lank(s) and piping be deconlantluated? YES (X[ NO [ [ <br /> C. Describe method used to clean tanks) and/or pplping lit not h,contractor's ma-)4 <br /> Me tank (s) acrd associated pip}Og W 11 by triple rin!jed on site by <br /> J.T,U. c - rMonst. ManIng procedure will consist othree <br /> rinses w1th seam or hot Water. ffinsaEe procedure Is on tile in youP ollic , <br /> 1 d Describe how rinsale material will be stored an sloerior to manifesting offsite: <br /> P 8 <br /> La ul i l ha ramoved from f he rank i s I .1.p J fia Morrpe D 11 / iti rh_MartR— <br /> f,1]CsLatrf lion fla.7atilaus Wagta I1-ail]er; Ila lP_r - —.Ixatit n Mi inher- -2667 ,- <br /> T rii]9a�.f3_!!1I L hP plarail it] %trtuus aild LraimpDrLati by tjs La nrjr-yayil� <br /> ..._at. RQ7 Hrark Diamprid Sax- lixii , Ca_ FPA {'A <br />' $ Siate Registered Hazardous Waste liauiera and kemaitled Disposal Facilities <br />' rl. Residual/ilazardous Waste llauler <br /> Namo o al 011 Waste oil mauler <br /> Address Eg - <br /> CUy Renair, Ca. 95316 Stale Zip <br /> Phone No. El{ 00 ) 332-8 10 fluuler Registrailon #CAD 982411255 <br /> b. Eventual disposal of rittseate may be Refineies Service 13331 N. Hwy. 33 <br /> Paterson, Ca. 95363 or other approved disposal facility. <br /> Page 4 <br />