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1. a Is there a MEND contractors and subcontractor's questionnaire on file or enclosed? YES NO r <br /> (b) Is the current certificate of workers compensation Insurance on rile? YES W NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES Pr NO[} <br /> (d) Has everyone on site,including cranelbackboe operator,been certified I <br /> to work on hazardous waste site In accordance with CCR Title 8? YES W-NO[] <br /> L2. Has a"Site Health&Safety Plan"for this job site been submitted? YES F( NO[] <br /> 3. Has ap licaut performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A 1jri YES;j NO]] u YES, Permit d <br /> L ii <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[af'YiS(]NO[] <br /> s <br /> 5. is there knowledge or evidence of leakage from the tanks)and/or piping? (If yes,please explaln)YES[] Now � <br /> i <br /> L6. Ir tank residual exists,Identify transporting hazardous waste hauler: <br /> 3 <br /> !Name�}H�¢/�, I/9cl�rz. L• r�aiG Santer Reglstration# 3ffir <br /> p <br /> Address Pv• 4w"3�W CityO�Z Y/ Zip .9 <br /> Phone 0( -Zoe 1 /-porn-73 Z--4/6 YS-- <br /> L � <br /> 7. Recontamination Procedures: 7"Y15 ZIPye o� <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[[ NO[] <br /> L _ <br /> b. Identify contractor performing decontaminatlon: <br /> Name &PY"45y <br /> 1 <br /> Address 3s3Q �a�.r� C�y,� City Z[p 957.0 <br /> i <br /> Phone No.( ZW f <br /> C. Describe method to be used for decontamindon: <br /> �� vvy ✓ e d Y �/ Q2�r5uCc� <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility-. <br /> Hauler Name /�.�.�✓ Hauler Registration M <br /> Address Clty 49e4W/ ZIP <br /> Phone No. <br /> Permitted Disposal Site 1/VIP&O di�9G D/L Sf'O/p� to ��,, <br /> - - <br /> AV <br /> EH 23 046 (Revised'10119" page 4 <br /> f <br /> i { <br />