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OIL rile or enclosed' YES PI N011 <br /> 1 (a) is There a FSS-EBD cantzct;r's and saboaaaac'ar's xor%w aon a ? YES No I I <br /> bl is the caxtrat cert:fleste of WorYar's compensatim iwmnnrs on tlle. YES N¢[1 <br /> (r) Does she sonr:aetar Possess a.3azar'daos Substance Rema7al carSrieatlon"? <br /> (d) Has 3aer7on3 an site.taclndir.g canetacilhoo aperw:'been certlried yr-S N9 i 1 <br /> res work onha:¢rdous WA313 site 11 s�!or]aaca wltk'03 Tme 32 <br /> YES NO[1 <br /> gas a `Site Health S 3afetT Plaa" for this jab site been submi:.ed? <br /> � <br /> ?. BasapPE=111 performing remo <br /> val In tte tlty of Tracy autained a"Grading and H;xavatton Perini:"? <br /> N. YES I NO(; If YES. Permit# <br /> 1 Bas rhe contmesr obtained sporcva'trom the local flrt department to Pertornt tank onri'nr QK1 <br /> 1 l 1 <br /> or evtdence of leakage iroe the taa::(s)am&=RipUW fit yes,please explain)Y3(1 N0 <br /> is Mar. <br /> =Owledge <br /> g, rite' ta` <br /> hazardous aa*w bszlerADO p <br /> 1 tyresidual Wsu.ldeariy Poj" <br /> � asTe' iHaulers Hauler dagsnm <br /> Name <br /> Denair , CA yp 95316 <br /> Address P.O. Bos 645 +tty... <br /> — <br /> p$a¢e 41 800_t 322-8710 <br /> Decrntaminadm proeada"r. <br /> a. Will melds)and pt"be Cacontamlaated Prtar to removal'. 713(k 40(1 <br /> b, Idecdfj ea¢traetat pe:fat�ing deceatamins=o¢ <br /> Name Jim Thorpe Oil, Inc - <br /> P.O. <br /> nc .P O Box 357 Ciry Lodi ,CA _IlP 95241-0357 <br /> Phone 114.(_2 0 9 1 3 6 8-617 <br /> e. Describe rsethad to be%sad far detanfaminadO'L p <br /> manner. <br /> S Descebe has rta$&to materiel will be stored oaslte Prior t¢maatfestt¢g offstte: <br /> Rinseate will either be removed from t a t kPst nd^1 ' nhias <br /> s <br /> thev ar ei z <br /> truck, or be stored in sealed drums until it can be disposed of <br /> e Nlnsve Haslet and Pormlttad Tttattaant.Storage d,IYspa9at PadmT. <br /> gaaer Hama <br /> Same as #6 Hamar Sagts`arion t — <br /> C[t7 �P <br /> ,Sdd:tSe <br /> Mae No.(.` t <br /> Amer -clear' , Inc . 2570 Almond Dr . Silver Springs, <br /> hrna-MV. or other approved facility. <br /> Page 3 <br /> ES 22 049 (geyt93d 08113!94) <br />