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11/20/2006 15:27 289468343 EHD • PAGE 01 <br /> I <br /> Oct Os 06 09:568 P R Engineering 8188423760 P• 4 <br /> 1. (a) Ss there a 1rSm contracror's and s,b,,,tract questionnaire on Elie or enclosed? 1�5[[ NO[ <br /> (b) Is the current ceruficatt of worker's comPeftmtioh insurance on file? [) <br /> (e) Does(he contractor Possess a"Hazwdom Substance Removal certi£scation'".r No[) <br /> (d) Has everyone on site,including acne/backhoe operator,been certified to work on YES <br /> NO�� <br /> (e) l,.dour waste site m accordance with a- Ti�]e 8? <br /> 2. Has m"Site Healtb&Safety Plan"for this job site been anbMlitted7 <br /> a"Gradin and Excavation Permit'? <br /> f t uJ tsJ� <br /> 3. Has applicant performing removal in the City ot.Tr�cy obtained $ <br /> r;rHt� Ynsj] NO!] tfYES, Permit <br /> 8 <br /> a cartra2+nr obtained apPravai from thelacalifae d'epartMent to perform tank cutting?NA[)YES[] NQf�- <br /> ,. . ..,:,..•tn+ rr asi�n;r�cf i-mileage frmn the(2nk(s)and/or piping? (If Yes,please explain)Y55 <br /> r[ '3. •a... o M---•11;•!r 315?Jor imgh er&iUs u^x5t4 t Pvier. <br /> Hauler Registration tF 1 a;/3 <br /> Adk's�s r' /pt j uyy � rit,R ICAA R]owy zip q--6151 <br /> 7. r-econtami in Prw'edmes: <br /> o, Wit! and Piliu3gbe decontaminated�rior cn removal? YES NO[] <br /> b. Iderefy con for performing decontamination: <br /> Name d G <br /> Addres< :• Kz�vdary- city Zip 9 7c <br /> 'Phone No <br /> c. B cribe rrrethad to toe sled for 3eeonta. <br /> Z d 09LEdbB8S8 �utuaaui�u3 8 H dSzk90 90 oe noN <br />