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P. 6 <br /> 4-06-1998 8:56AM FROM TAIT SACRAMENTO 916 635 2606 • <br /> >. (a) Is there a PHS-ETD contractor's questionnaire on file or enclosed? YES NO { [ <br /> YES NO I I <br /> (b) Is+the current certificate of worker's compensaat on�Be*l onqfile? "� YES NO [ [ <br /> (c) Does the contractor possess a^HmrdaaSubstance <br /> (d) Has everyone on site, including erandbackhoe operator, been certified <br /> to work on hazardous waste site in accordance with CCR Title 9? YTeS NO 1 I <br /> 2 Hasa "Site Health &Safety Plan" for this Job site beensubmitted' YES j NO [ ) <br /> 3. Has applicant perf�oprming removal in the City OA obtained a "Grading and EznnaPe <br /> tim rmit"? <br /> N/A I I YES W NO I I If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ I Y4 NO[ <br /> S. Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explant) 'YES I j NO <br /> b. If tank residual exists, identify transporting hazardous waste banter: <br /> Name r"1�AXf mum �rrt�/� <br /> Hauler > 'hOn a 3 7D <br /> A, ,r n.,S(�x DL--Al-2n z city t1Q le 0 zip <br /> Address�� <br /> Phone #( 70 7Z <br /> 7. Decoatambeatitm Procedarea: <br /> �I <br /> R. Will tankYES s) and piping be decontaminated prior to removal? NO { j . <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address ( I Zt3 F��� r. City. n 4Q ens A zip ti lso f — <br /> Phone No.( 70-7 <br /> C. Describe method to be used fpr decontamination: <br /> IAIG 'r rin�ar <br /> d Describe ho ri to mu 1 Will be stn onsite prior t0 maaifearing of(hite <br /> Lab� e� <br /> Rinsate Hauler and permitted Treatment Storage & Disposal Faeilityt <br /> Hauler Name 1�AXtn�vo-n r"lr� Sfv��rre _ Haaler )fiegiatratios+ # <br /> 36 70 <br /> AddtYss (�a R�6�� [�� R �- 28� city ( I_ � Zip 7�IS1� <br /> Phone No. ( -7070-7 <br /> III I (I <br /> Permitted Disposal Site L <br /> 6t' <br /> 0 <br /> EH 23 046 (Revised 9/11196) Page 4 <br />