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FKUM p 7 <br /> 1. (a) Is there a PHS EHD cordractars and subcontractors questionnaire on Ate or enclosed? TES j�f NO(] <br /> (b) Is the current cerd&ate of workers compettsaCoIL insnranca on ate? IM NO I 1 <br /> (c) Does the contractor possess a"Hazardous Substance Removal CargIlcatlon"? TESV NO(] <br /> (d) Has everyone on site,iachtdlag cranelbackhoe operator.been certiaed <br /> to work on hazardow waste site in accordance with CCH 12tle 8? TES NO!1 <br /> 2 Has a"Slte Health&Safety Plan" for this lob site been submitted? YES,(r NO(] <br /> 3 Has applicant perfortaf ig removal In the City of'1raq obtained a"6radfng and Ezcavatiou Permit"? <br /> rira,4 TEs i I ND f1 u TES, Permit 1 <br /> 3. Has the cnniractor obtained approval from the local are department to perform tank cutting?I a YES(]NO(I <br /> S. Is there knowledge or evidence of leakage from the taak(s)author piplar (11 yes,please explain)M(( N0k <br /> 6. If tank residual exists,IdeuM transporting hazaarrddoous waste haafer. <br /> Name ��1 Z� V Au, 1 Ranier Registration 1-3144 <br /> Address �i�9�b3 ( R Q n( 11�r city ( 1 j�1 ) C4a, zip_ 1 <br /> Phone d <br /> T Decontamination Procedures: <br /> a. Will Wllgs)and piping be decontaminated prior to removal? YES NO(] <br /> b. Identify coumcrar performing decontamtnattoa <br /> Name "L-T&-4- <br /> -P <br /> Address Iv D)xq —tet u A�OE�r city Tip <br /> Phone No{S�M. ) VI S—) <br /> C. Describe method to be used for decantiminal z: <br /> S�t&m --� P Q-�t nib- 6F RI N <br /> ALAI tisk 5.7 d-a \ <br /> d. Describe how rinset�m.aterinl willbe stared onsite prior to maatfesilag ofislte: <br /> T — KI wx t✓ wul— W Pi�m-P cs►�T 11,E 1,a�I�`� <br /> y VM—LLS W 14A Le S sl@rrt�Llk <br /> e. Rlusate Hauler and permitted Treatment.Sromge&Disposal Facdaty: <br /> Hauler Name_ AwTs)q l Civ r v VAUM Hasler Hegistradoa <br /> Address &163 914f-fy, � LAAcity DIEU;1j C*zip9531-5 <br /> PermtttedDlaposaiSffa <br /> EH 21046 (Revised 10719198) Page 4 <br />