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AD to <br /> • is there a contractor's questionnaire on rile? NA [ J YES t4 NO J J <br /> a) Is the questionnaire enclosed? YES [ j NO J�J <br /> b) Is the current certificate of worker's compensation insurance on file? YES JJ NO J <br /> c) Does contractor possess a 'Hazardous Substance Removal Actions Cert "? NA J J YES 14 NO j J <br /> 2 Has a 'Site health & Safety Piaci' for this job site been submitted? YES } NO J j <br /> 3 Has applicant performing removal In the Clay of Tracy obtained a 'Gruding and hxcuvutiun Pernllt'? <br /> N/A)J, YES [ J NO I J If YES, Permit # <br /> 4 Have lank(s) or piping pending removal leaked In 1110 past? YESNO + J <br /> Unknown <br /> 5 What will be the disposition of the tanks)/piping? <br /> pjRjag_WjjLbe trlpje pinsed and disposed of <br /> 6 Has the contractor obtained approval from the local fire department to perform tank culling? NA( J YESfXJ NO[ J <br /> Decontamination Procedures. <br /> a. Identify contractor performing decontamination <br /> Name Jim Thorpe Oil Inc. d.b a. Rich- Mart Construc.tioti <br /> AddresI''J 11 ec roan po x Clay Lodi Zip - <br /> 0357 <br /> Phone No[ , - <br /> 6175 <br /> b Will tank(s) and piping be decontaminated? YES JXI NO J <br /> C Describe method used to clean tank($) and/or piping (if not Ill conrracror's file). <br /> The tank (s) and associated pipilig will be triple ribbed ori blLe by <br /> oceura res <br /> Rich r <br /> rinses wi seam or o water. ansa a procedure is on i e in your a ice, <br /> r <br /> d Describe how rinsate material will be stored on site prior to manifesting offsue• <br /> he pj;jcpd <br /> �rr-ed by ii4 tci_nur mai <br /> -d in (irijagi arid 8 State Registered Hazardous Waste Haulers and Permitted Disposal Facilities <br /> a. Residual/Hazardous Waste Hauler <br /> Name.-Nor-Cal oil, to oil iaulerg <br /> Address e B <br /> City Dema r Ca. 316 Slate Zip <br /> #CAD 982417255 <br /> Phone No. a� as 332-8 10 Ilauler Reglstrullou <br /> Page 4 <br />