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1, (a) Is there a PHS-EED contractor's questionnaire on file or enclosed? <br />YES NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on file? <br />YEs Not 1 <br />t ] <br />(c) Does the contractor possess a Mszardous Substance Removal Corti&cion'? YFS NO <br />2. Has a *Site Health & Safeq Plan' for this job site been submitted? YES NOL 1 <br />3. Hasa applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br />N/A>4 • YES E I NO t I If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA 7-1 <br />N YES( I NO( ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ I NO <br />6. If tank residual exists, identify transporting hazardous waste hauler. <br />N�{'1 crL'..�oa• v.!' <br />Hauler Regisoration # O c `j <br />ame <br />Address 2 <br />e3 �.ry v31�/d-. City 1&��1., ...a,..d Zip <br />Phone # ( 5 ► ® ) 23 1-3 q 3 <br />7. Decontamination Procedure= <br />a, taminated prior to removal? YES �' <br />NO <br />Will tank(s) and piping be deconE l <br />b. Identify contractor performing decontamination: <br />Name E el' 1'"`G" <br />Address Z � 5 1��.r-r- <br />f31,i'c� City )a;• 1.,.., "'J Zip Gi' Ss o l <br />Phone No.( 5 o ) 2- <br />C. <br />c, Describe method to be used for decontamination: <br />)e- <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />ZA <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Registration # ' '► <br />Hauler Name I`' L ` ^- I ^ c" ' <br />c1- �i `--ad <br />Address 2 5� ���'-r- 1 v24 city 12� moi^ rr o,^ Zip o <br />Phone No. � � o <br />23 S — a 3 53 <br />Permitted Disposal Site�- <br />Page 4 <br />