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. I *bec-03-02 10: 52A Wen Construction 209 47 9310 P_02 <br /> Jit d�d er,d` <br /> ,i. <br /> ,Y <br /> (a) is alai a FR&M co is andu n4w-ftes questionnaire on file ore ? YESIK NO[1 <br /> s:x (b) is am wnnt certificate of worker's compensation ae an tile? TEStf N0 i) <br /> (c) Does the coaftator possese a*11azardous Substance oval Certification"? R NO[1 <br /> (d) Miss everyone on site,Wdudlng craualbaddW operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES NO[1 <br /> 2Ras a*Site Health is Safety "for this Job site been submitted? YES[) NO Jif' <br /> 3 cant performing removal in the City of Tracy obtained a'Grading and Excavation Permit"? <br /> NI =I] NO() It YES, Permit p <br /> 4 the contractor obtained approval from the local fire department to perform tank cutting??NAI)YFA)NOK <br /> 5. Is there knowledge or evidence of leakage from the tanla(s)and/or piping? (lf yes,please explain)YES[) NO <br /> 6. It tank residual exists,Identify transporting hazadous waste hauler: <br /> Name } Hauler Registration M <br /> r <br /> Address <br /> city ZIp <br /> Phone#( 1 <br /> 7. Decontamination Procedures: <br /> a. Will takJoand piping be decontaminated prior to removal? YES ' NO(] <br /> b. identify contractor performing decontamination. <br /> Name k-3er-,4A+ Cr3y-,o4-e�e-AliiA <br /> Address ���, �y t3 City 1,61 zip <br /> Phone Nc.{_20`,�. _) S-LO-9.310 <br /> c. Describe method to be used for decor on: <br /> t 1 ► s b 0 tlelo <br /> d. Describe how rinsM material will be stored onsite or to manifesting off : <br /> T ►1M&CA 0- ; b <br /> e. Rinsate Ranier and permitted Treatment.Storage&Disposal Facility: <br /> Hamer ftme ( toNe L Lx_.)e i� e Hauler Registration p i a <br /> AddressP.® , �[�, 1` (sty �p <br /> Phone No. <br /> Permitted Disposal <br /> Hxsaas IO/i sssrs 1� Pate 4n�.\ PoxA-1a , Oct,, I V O <br /> OR�e> Igo-741 `i3y <br />