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. ,TRT .EOUIP .CO TEL No . Feb 28 .97 11 19 No .005 P .01 <br /> /��Ufa" LM rc6r*t�rrN � <br /> 6'1"-)T400 <br /> I (a) Is there a pHs-SBD contractorsquestionnaire on file or enclosed?(b) Is the current certificate or worker's compensation insurance on file? [ ) <br /> 11 <br /> Removal Certifiatiou-, yES F'1 NO [ 1 <br /> YES [7 <br /> (c) Does the contractor poasesa • 'Haardous Substance <br /> [ <br /> 2. Has a 'Site Ream a Safety Plan' for this Job site been submitted? <br /> ) <br /> obtained a 'U,&diog and Psovatim PeimltR <br /> 3. Has app ape I�g tem [ )n the Clry TraIr�h Permit # <br /> N/A <br /> 4. Has the contractor obtained approval from the local fire department to perform to cutting". NA S[ l NO( ] <br /> S. Is there knowledge or evidence of leakage from the tanks) and/or piping? (Ir yes, please explain) YES [ I NO (� <br /> 6. If tank residual exists, Identify transporting hazardous waste hauler. <br /> C Hauler Registration # 25 <br /> Name - � <br /> City ZEl 110-j zip <br /> AddrrsslzaLL <br /> Phone # � <br /> 7. Decautammadon Procedures: / <br /> a, Will tank(s) and piping be decontaminated prior to Moto"'? <br /> M [ . <br /> b. Identify contractor performing decontamination: <br /> - <br /> Name_ — <br /> y Zip <br /> Address „� De /�i�— City"� <br /> Phone No.( —J— `'"�� `�•� <br /> C. Describe method to be aged for d atom ation: r L`. �- <br /> l.c �q U-t <br /> .jn be stored onsite prior jo manifotin onsite: <br /> d. Describe how rlrtsate mot� ,l 1 <br /> e, Rinsate Huuler and permitted Treatment, Storage & Disposal Facility: <br /> ` �FYlrk-S Hauler Registration <br /> Hauler Name <br /> '/ City <br /> Addressl3 (`fr NlsYf 3J <br /> Phone No. <br /> Permitted Disposal Slte <br /> Page 4 <br />