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tic_ I I u 14LJGJ lti(b2 <br /> 1_ /a) Is era a P&S cuatzactar's and its gnestiomiatre on IIIe ar eizdosed7 YES0 I I <br /> (b) Is a currcnt mtflcate of workers campeasaa=Insurance ou fae7lao I] <br /> (c) Do the caatractor Passers a"$a=rdvus Substance Ramoval Ce=carinn"? YES V No I] <br /> (� every0 6 on site,lneinding Crandbacuum operator,been certified <br /> to or%on hAzdons Waste site In a=rdauce with CCR TWe 8? YES WNU[I <br /> Z Hasa Sita geatth&Safety Plan' for this job site bear suhiulttedT <br /> YES M NO I] <br /> 3 Has anAlcan <br /> t rforming removal In ttW City of Tracy o bta ned a"Grading and I�.cavatfan Permft"7 <br /> N/A YES(]' NO]] it YES. Permit f <br /> Has the contx7xtor obtained �/ <br /> appivvai Ltvm the Iacai fine department to perform t tutLingtMAI�I]NO[] <br /> i. LS ther j knowledge or evidence of leakage from the t=qs)andlor P4 t V (u Tar,please ezplaiu)YES <br /> I I No <br /> I <br /> If tank residual eXLSM jdendfy t 7m5pordmg hazardous waste haulm- <br /> Name' �7�CuaiZv Ti2uCf��i�(� COg ioc,4J �lt�'i rvcJzbc� <br /> Hauler Registration <br /> ♦pis <br /> Address__f� c� i3�,,C 2� r3Y� � zip <br /> Phoned <br /> Deco adigrf Procedux= <br /> a.: s)and PiPIZZ be decOW-ambmted prior to removal? <br /> TES WINO I I <br /> h IdenMy.coaU7wtor Performing de=ta.miaatiam <br /> Name <br /> Address: 7 S S ��� (��;✓�� Qty A2 ?gyp <br /> Photte <br /> C. Describd method to be axed for dgenntamfnatinn- <br /> J iZ <br /> d- Desaribd have Ansate materia.(Wit!be stared aasfte tutor to Maui, <br /> e. Flnsa tt8 Hauler and Pemiired Treatmeut Storage&Disposal Facility: _ <br /> Elxuler lgame ��r LA2D' TlZcicK Jnr l <br /> Hauler Regisomtlon <br /> t.21 '►E -17 .5 <br /> Address �p T <br /> Phone Po. - <br /> ?c de' �cTr2.ti7�.vC0 �7c/Z �Nc/t � <br /> Permiti�d Disposal Sita <br /> 23 046 (Revis d 10/iSt } Page 4 <br />