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' YES [X� NO [ } <br /> (a) Is there ■ PIISt-EIID contractor's questionnaire on 1110 or enclosed? <br /> iYES VQ No [ 1 . <br /> (b) Is the current certificate of worker's compensation Insurance on file? <br /> (c) Does the contractor possess a "I1 Subslnace Reaua.ai (,rrMatlan'? <br /> yF.Q [X) NO [ l <br /> Z. I1as a Site Hesitb A Safety Plan' for this job site been submitted? <br /> YES [X] NO [ ] <br /> 3, llns applicant performing removal In the City of Tracy obtained a 'Gradin simd Exrsrotlon Permll ? <br />' N/A N YES [ 1 NO [ 1 U YES, Permit <br /> 4. Has the contractor obtained approval from the local fire department to perforin tank cutting? NAM YES[ l NO[ ) <br />' 5. Is there knowledge or evidence of leakage from the lank(m) and/or plping7 (if yes, plesse explain) YES [ 1 NO <br /> 1 ' <br /> 6. If tank residual exists, Identify transporting hazardous waste haulers <br />' <br /> Nam _ e oil hauler haulrat <br /> hauler Registration #CAD 982417255 <br /> e Ux. Wast <br /> Address City Denair Ca. Zip 95316 <br />' Phone # (_ 209 332-8110 , <br /> Y}�ntaminatlon F'raceduraes <br /> a. <br /> minated prior to removal?FVtil tank(s) and piping be deconta <br /> YES [ 1 NO [ 1 <br /> Identify contractor performing decontaminations <br /> Name Jim Thorpe Oil, Inc./ DBA inch-Mart Construction <br /> I <br /> Address 351 N Beclonan Rd. City Lode. Zip 95240 <br /> Phone No.( 209_) 368--6175 / 462-4581 <br /> C. Describe method to be used for decontaminationi ion. <br /> iduals. <br /> d. Describe how rfnsate mnterfat will be stored onslte prior to manifesting offslte: i fp ll <br /> I fiinsate will be storedin i r <br /> e sealed alit! .labeled until QUnj2gd <br /> e, Rlnsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> hauler Name No <br /> hauler Registration # CAD 8241 255 <br /> IAddress City Denair Zlp 95316 <br /> Phone No. ( 2U9-,—J — <br /> Permitted Disposal Site fiefiner° Patterson Ca. or ott3er^ a cality. <br /> a <br /> I Page 4 <br />