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Is Ihete a ITIS -13111) coohAclor's goeslionnaite 1111 file or eticlose dl Yf3S 1XI NO <br />(b) Is the cmrcul cetfilicale of wotker's cornpellsAfion losutame on file? Y13S I)Q NO <br />(c) Does lite coalrAclot possess a "ilualdous Sobstflo a Removal Cetlificalioo?" YIDS Im NO <br />2. lips a ,Site Ileallh & Safely Pino" for This Job site been sohndlled7 YES 13Q NO <br />3, ilAa Rpill{talll pClh/llldllg tett(/IVAI itl IIIC lily lrf'IlRey obtained "Utading And13xCAVR1{IIn Petnl{I"? <br />N/A IX I YI3S I I NO I I If YHS, Penoll N <br />4. Dns cooltoclof oblpinell apploval fllotl (Ile Iq"I lite lleparolleol 10 perfotnl lank cotting7 NA IXI YES I I NO 1 1h <br />5. Is Ihete knowledge or evidence of IcakAge Root the lank(s) cold/or piping? (if yes, please explain) YRS I I NO vy <br />6. If lank tesidoal exists, ldcolify Ifposporling hazardous waste hauler: <br />Name: Nor -Col Waste Oil llnulers Ilauler RegisuPlio„ N: CAD 981417155 <br />Addless: 11.0. Box 645 ---- City: Denalr, CA Zip: 95316 <br />I'honc: (109) 331-8110 <br />1. beconlnndnationPrlrcedmes: . <br />A. Will lallkO.$) and plplog Ile lleconinnlillaled prior to tctllovaf/ YRS 1XI NO <br />Ir. Ideolify connaclor perforndog declollaulinatlon: <br />Name: Jim Thorpe OII Co„ Inc. <br />Adlhess: 35t N. Uecknlmt Itond / P.O. Ilox 357 City: Lodil CA Zip: 9524111 -901 -- <br />Phone No. ,109 4►_61-458t or J20� 368-6175 <br />C. Describe toelhod pr be osed rot decoolaminalion: <br />Tanks Pod piping will be Wide rinsed with hof woler Rod biodegradable soap 3011111011. <br />d. Desctihe Ilow thlsnle nlalcrial will he slolcd on -She plim to ronPifesling off-site: <br />'1 he rlosPle 1011 Ile removed by .Ihn'Iborpe 011, Inc., persomrel and he placed In drums, The <br />dloou 1111 he Inbfetl mrd slolcd ml site PwAillug pith up for disposal of it proper disposal <br />C. Ithrxate IIAPIef Rod pelntitled *1lemolletd, Storage & Disposal Facility: <br />??puler NAnle: Same Al No. 6 (looter Regislrafion N: <br />Addless: City: Zip: <br />Phooe No. <br />Pennilled Disposal Site: Itelinerles Ser vices,l'allersoo, CA, or other approved f tclill,y. <br />Pogo 4 <br />