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�F <br /> (a) Is there a PHSEHD contractor's and Buhractor's questionnaire on[Ile or enclosed? YES[-I-'NO[] <br /> (b) Is the current certificate of worker's can_ :salton insurance an Me? YES[-}ANO[] <br /> (c) Does the contractor possess a"Hazardor . abstance Removal Certification"? YES V NO[] <br /> (d) Has everyone on site,Including cranelba >-`:ae operator,been certified <br /> to work on hazardous waste site In accarc: ice with CCR Title 8? YES[k'NO[] <br /> 2. Has a"Site Health&Safety Plan" for this jo. .Ae been submitted? YES[.}ANO(] <br /> 3. Has apgPaut performing removal in the Cit; Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[ YES[J NO[] If YES, Pe., A# <br /> 4. Has the contractor obtained approval from L !oval fire department to perform tank cutting?NA[ S( NO(] <br /> 5. Is there knowledge or evidence of leakage f: the tank(s)and/or piping? (If yes,please explain)YES(] NO w]� <br /> 6. It tank residual exists,Identify trausportln_ .zardous waste hauler. <br /> Name JA Vx�cp J y( e.-4\iIRD�aulerRegistration#3y74/y <br /> Address U city D E t-A 1 Zip <br /> Phone#& 00 ) 73 2 - Y/iYJ <br /> 1. Decontamination Procedures: <br /> a. R7H tank(s)and piping be deconta:_ ated prior to removal? YES*?"'NO(] <br /> b. Identify contractor performing dec, caminatlon: <br /> Name a' Tbck Oro �Gn.. 'ate Sfl rt0fJ iE� 60 <br /> Address gp8 NO, tjrlto< St. city S1'0C1CDr`t Z1p(?y' � <br /> Phone No4 Uq ) 416 q ?333 <br /> c. Describe method to be used for dec :aminatlom <br /> T4z,i�I�_ SSE <br /> d. Describe how rinsate material wtL . stored onsite prlo to manifesting offsite: <br /> H �r�c_...tta6O st gtt i��u THE -Z4d1-- <br /> a E_f l-yyf .on1 M-A-1Wrrst. <br /> a. Rtmsate Hauler and permitted Tre; ::ent,Storage&Disposal Facility: <br /> i <br /> Hauler Name -,7 tCj4,6qi�Eo/�NVbfiwirdq�4HanlerRegtsttatlonl3rl4/V <br /> AddressR7 . Y� d7. 3 r: -., City t>eC-N+ l ZIP 5 3/s` <br /> Phone No. Boo TJ L. -- qC 95- <br /> Permitted Disposal Site <br /> 5-PermlttedDisposalSite .,n ,<: ;?44t"_ +c- <br /> l'loo sora ST, , / AA4s,�s/ rtSZo 3 <br /> EH 23 046 (Revised 10119198) Page 4 G� Pf-O T?IfSZ ?O <br />