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11 <br />YES;q <br />1 <br />(a)Ls there a MEHU centrxctor's gad sabetminctar's questiontwlre on file or enclosed"" YES � NO [ ) <br />,0} Is the current certi:aeate of worker's compeasatku ittsu=ce an tile. <br />(r,) Dces the contractor p4SSesS a'Hazardons Substance Itemolal Cartlfleatfan"? YES M No [; <br />(d) Bas 37er7oae an site. including a'sne'badhoe operaco:, beer c8lV10d YES KO <br />to wc:� on hazardous waste site in ucordance with LCR TM 3? � [ l <br />2. Has a 'Site Health & 3afety Plan" for this job sits been submi:ted? YES M NO[] <br />Eq appii:= performing removal in the Qty of Tracy obWned a "Grading and E=avadau Permit"? <br />If ns. Permit # <br />4. Has rhe contracmr obtained apprCMI from the local lire department to perfcnn tank mtthC �S[ 1 K j,- <br />3. is tber° mowledge or evidence of leakage IM the tan:t(3) a.-d:cr piplug? (if yea. grease explain) <br />YES? I j PlQ <br />�. If tank residual exists, ideatit37 transporting hazardous wa;'te hauler: <br />Name <br />NORCAL Waste Oil Haulers Hauler Reglstmtlon0 CAD 982417255 <br />Address P.O. Box 645 Ctty Denair, CA at)95316 <br />Pion #( 800 1 322-8710 <br />Dermmminatloa Procedures: <br />a WIU tank(s) and piping be decontaminated pr1oc to removal? YES jk 1011 <br />b. I&Xdfy contractor performing deCUMMine-0a: <br />Name Jim Thorpe Oil, Inc. <br />.02'es; P.O. Box 357 QEY Lodi, CA ZIp 95241-0357 <br />Fhonefto� 209 ) 368-6175 <br />�;. Describe method to be usad for decoIItamination: <br />T nk/q) will he tr;tilP q"p <br />be deee ire tie manner. <br />3. Desceibe hope r1wate material will be stored onsite prior to maaitesting offsite: <br />Rinseate will either be removed ,from the tank(s) and lines as <br />thev are being rinsed b the 1 r yQ his <br />wtruck, or be stored in sealed drums until it can be disposed of. <br />P- B.insate Hauler and permittad Treatment, Storage & Disposal Rac'.ilty <br />iiaollar HamaSame as t 6 Haalsr Reg -24on ik <br />dddr ass Cif ZIP <br />PhomNo.! 1 <br />p®rmi,,dt7isposalglte Americlean, Inc. 2570 Almond Dr. Silver Springs, <br />i�V. or other approved facility. <br />E.E 23 O,tS (Ratnsed M 13M9 Page 4 <br />