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1. Is there a contractor's que,�uonnaire on file? NA ( ] YES NO <br /> a) Is the questionnaire enclosed? YESNO <br /> ( ] I <br /> b) Is the current certificate of worker's compensation insurance on file? YES NO <br /> C) Does contractor, possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES NO [ <br /> 2. Has a "Site Health & Safety Plan' for this job site been submitted? YES NO [ <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A YES [ J NO ( J If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? YES [ ] NO <br /> 5. What will be the disposition of the tank(s)/piping <br /> D S r 7T•4NK IR, <br /> iV L,)tLL E L -V/ <br /> a <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[q fES( J NO[ <br /> 7. Decontamination Procedures: <br /> a. Identify contractor performing decontamination <br /> Name GO <br /> Address 3 City lkl p DES 1-0 Zip <br /> Phone No. ZO 52 S- 96 S 3 <br /> b. Will tank(s) and piping be decontaminated? YES [tom NO [ <br /> C. Describe method used to clear tank(s and/or piping (If not in contractor's file): <br /> T4I&e s �I�fiD f�/PiN� Gy/t F3 E T/l�/�G E /•�/S E ,t� /�{j o <br /> T� iR > i.vSF r E /viTr1 rE � Cl/ <br /> E� E r�vo <br /> A- <br /> d. Describ how rinsate material will be stored on site prior to manifesting offsite: <br /> 7e 2 4614 <br /> E� <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual/Hazardous Waste Hauler <br /> Name G P D <br /> Address <br /> City e o�0 ES 76 State !gt Zip S Z <br /> Phone No. ( 09 ) S-7,(2— $S 60 Hauler Registration # /I,SF3 <br /> Page 4 <br />