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Mar-16-05 01 ;42pm From-Gattlar-R- Inc +9166311317 T-620 P.002/007 F-297 <br /> (b) Is the current certificate of worker's compensation insurance on file? YES,[ NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES M NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> (e) hazardous waste site in accordance with CCR Title S? YES[?d NO[] <br /> 2_ Has a"Site Health&Safety Plan"for this job site been submitted? YES a] NO[] <br /> �Kra� <br /> 3. Has applicant performing removal in the City of ltaq obi4ined a"Grading and Excavation.Permit"? <br /> N/A[] YES[] NO[] If YES, Permit# %5� �7nvG-%O C,7'1 DF-5, 7ra�J <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[(NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO* <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> -T-b AM-Ac Ft's W D2 C� F'M✓► AP 4rHs SG''wf/e 6dj y,-<- <br /> Name Hauler Registration# <br /> Address City .Zip <br /> Phone# <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESk NO[] <br /> b. Identify contractor performing decontamination: 'IP-L-Fneve, 1-0 1-1.pyyy1S SUIeG'S�1 ie�G• <br /> Name <br /> Address City Zip <br /> Phone No.( ) <br /> C, Describe method to be used for decontamination: <br /> '��t''YZ_ -� 1k�1-►'�4 S[�►"V/Gy�_1nIC. 41.?Ur1t. -� L-Gl7�-'yam <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite- <br /> F! RIem -TQ 14AA.S SZe2y/C 6-S Lu,-A c_ aA+ !2 t._ro=t7(Z <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: CJ,-_C?Zz ZS�� <br /> 'Q�-pr1cZ,-'p vA",V,- -sou ICU--5- W -e, V(440--) L-t-t'TLP, / <br /> Hauler Name Hauler Hauler Registration# 2i1 l2 <br /> Address City Zip <br /> Phone No. (1 <br /> Permitted Disposal Site DnoJ <br /> EH 23 046 (Revised l0/16/03) Page 4 <br />