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DEC- 6-95 WED 1438 KLEINFELDER FAX NO. 2WMUb'L1 r lueu <br /> I. (a) Is there a PHS-EIM contractors gcestionnaire on rile or enclosed? YES NO ` ] <br /> (b) Is ate current certificate of worker's compensation insurance on tile'. YES^ c`fo C 1 <br /> (c) Does the eantnctor possess a 'H,,,ard, s Sobataace Itemo-al CertiGodoa'". Y�'S� NO ( 1 <br /> S NO [ ] <br /> ?. Has a Site Health & SaCctr Plan' for this job site been submitted? yE7�� <br /> >. <br /> 3 Has�lirtnc per'otming removal in the City of Tr-4c7 ..a�y obtained a 'Grading a :uradon Permit'? <br /> N/A YES ; 1 NO ( 1 If YES, permit m <br /> d. Has the contractor obtained approval from the local r1m department to perform tank cutting? IA YES[ ] NO( l <br /> 5. Is there knowledge or evidence of leakage from the tank($) and/or piping? (If yes, please e:rplain) YES ( 1 YOA <br /> 6. If tank residua( a fists. identify transporting hazardous waste hauler. 4� <br /> Name De:l �Ir.�rn.fw eT7�r,7 /�!� Hooter Regis>Tadcn <br /> Address' <br /> QSN.—� f f-0 City �_ J_� Ml� Zip <br /> phone <br /> 7. Deroataminatioa Procedurm <br /> y Will tank(s) and piping be decontaminated prior to removal". <br /> YcS NO ( 1 <br /> b. Identity contractor peearatinq decontaminations <br /> Namep <br /> Address -RA S i! -7- 1.�� City ' UDL _ lip C._E/$M <br /> Phone No. <br /> a �De5,tribe met d w he used}r'or deconmminat''an &MYOf 5( <br /> d. Dgg�,tribe how rinsate material will sto i7- to manifesting o(Lsite t S <br /> KinfS�wT ;Ll b� <br /> e, Rinsate Hauler and permitted Treatment, Storage do Disposal 7acjUtys <br /> ilawer <br /> Hauler Mame, �r�•Mrr[u�Oinl <br /> Addressy� <br /> , 3l�n��61� K l3 _ City t-Q�hLkS Zip <br /> phone No. (_p!�� <br /> permitted Disposal Site���G���yf�� <br /> Page 4 <br />