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t <br />1. <br />Is there a contractor's questionnaire on file? NA (j <br />YES [ ] <br />NO <br />a) Is the questionnaire enclosed? <br />YES [ ] <br />NO <br />b) Is the current certificate of worker's compensation insurance on file? <br />YES [ j <br />NO [ j <br />C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ j <br />YES [ j <br />NO ( ] <br />2. <br />Has a 'Site Health & Safety Plan" for this job site been submitted? <br />YES (j <br />NO (q--- <br />3. <br />Has applicant performing removal in the City of Traci obtained a "Grading and Excavation Permit"? <br />N/A ( ] YES [ j NO [ If YES, Permit # <br />4. <br />Have tank(s) or piping pending removal leaked in the past? (If yes, list tank) <br />YES (] <br />NO (� <br />S. <br />What will be the disposition of the tanks)/piping? <br />6. Has the contractor obtained approval from the local bre department to perform tank cutting? NA( ] YES[ ] NO(e <br />7. Decontamination Procedures: <br />a. Ideatify contractor performing decontamination <br />Name SL Iv V2 C.24ul yP?"-T -Q <br />Address 2 g& T e�Lo be- s M T City Zip !23210 <br />Phone No.( 2&9 ) 493 5-- o e/5dr <br />b. Will tank(s) and piping be decontaminated? YES [ ] NO [ <br />C. Descnbe method used to clean tank(s) and/or piping (If not in contmc:oes file): , <br />1;4tAwe. t..3r t / R C, " W-) E& er of Gi ' i;6 5 'VA L A <br />J I <br />d. Describe how rinsate material will be stored on site prior to manifesting offsite: <br />2iiusa-Ti.�' y�iZar�����i�„ t.��l/�sT®�t.�J iv ,.SS t�✓t�r�S <br />S. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br />a. Residual/Hazardous Waste Hauler <br />Name ir41ACSo <br />Address 2-.Z T 2 A <br />City State COAT Zip 9Y8o/ <br />Phone No.nLo 23 5-- L3 2 Hauler R oistration # 0l 9 <br />Disposal Site G M C dd:Z !'S <br />Page 4 <br />