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1, (a) is there a PHS•ERD cootractot's and aubcontractot's quesnonnalre on Ne or enclosed? YESI :/ D I I <br />rk <br />(b) is the currentcertincate of woer', compeusenion insurance on fuel YES NO <br />(c) Does the contractor possess a 'Hazardous Substance Removal CertWcXtien'? <br />(d) Has everyone on Alta, Including crenelbeckhos operator, been certified YES / NO I I <br />to work on hazardous waeto site In accordance with CCR 7104 87 1 T <br />p, YES() N0tt� <br />Has a'81k Bedth b Safety ?In' for We Job site been submitted? <br />3. <br />Has ap entperformingremovat S, Pty or Tracy obtAblida"Oradingand ExeavationPermit"T <br />NIA SII NOI) <br />4. Has the contractor obtained approval from the local fire department to perform tank turning? NAI SI 1 NO( I <br />S. Is there knowledge or evidence of leakage from the tank(e) andlor plping? (if yes, please explain) YES I I NO (+� <br />6. it tank residual exists, Identify transporting hazardous waste haler. p <br />Name G Balder Hegisttapea OI <br />7C� P A -P t= tom.`-`�-e;`�iUJ cltr3�`i��eu�w � �P <br />Address <br />Phone 01 /o J_ X35" Z3 3 <br />7. Decontsnwationproceduree: <br />a. WW tank($) and piping be decontaminated prior to removal? YES I I NO )y' <br />b. Identify contractor performing dtcontamlnanon: <br />Name _ i/A <br />Address city UP <br />Phone No.I I <br />c. Describe method to be used for deconlgnllaILdOW <br />d Describe how Ansate material wly rstored ensile prlorto manlfestlog efforts: <br />a, Rlasate Hauler and permitte <br />d Treatment. Storage & Disposal Facility. <br />Hauler Name / Q Ranter Registration f <br />Address <br />Clry ZlD <br />Phone No. <br />Permitted Disposal Site <br />RE 23 046 (Revised 08113199) Page 4 <br />