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f 1 <br /> t. a) lb there a PHS-EIIU conmicavN yue�tiolit afire on file•orenclosed". �QQ �1YES NO( I <br /> b) Is die current certificate of wtAcef s compensation insunuice on tile? lJ YESkN' NO( I <br /> c) Does the contractor pt)%sess a "Hazardous Suhctance Removal Certification"? YES NO( I <br /> 2. Hai a "Site Health & Safety Plan" fi)r this joh site been submitted? YES�4 No [ I <br /> 3. Has appitc.utt performing removal in the City cif Tnicy obtained a"Grading and Excavation Permit"? <br /> N/A I X i YFS ( 1 No I If YES, Penult # <br /> -i. KL, die contracior ohruned approv;l fn)jjt the ltka: rtre depumnent to pcttornt tank cutting? <br /> NA (X ; YES ( ; NO ( ) <br /> 5 Is there kiwwletl_e or evidence of leakage fn,m die t. ik(s)wid/or piping? YES ( ( NO <br /> (If yes. explain) Nr I,;z t - t' <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name &rU gA,=-2 S. Hauler Registration 0100 1 <br /> Address;*S5 'Parvo 61 s-N N City )YL44 KUw4 Zip x'141 X01 <br /> Phone No. IS 10 ) ...y S- <br /> 7. <br /> 13`3 3 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated pritx to removal? YES ( J NO <br /> h. Identify contractor perfuming dec-ontaminatiun: <br /> Name <br /> Address City Zip <br /> Phone No. <br /> c. Describe method to be used for decontamination: <br /> d Describe how rinsate m aterW will be stored on-site prior to manifesting off-site: <br /> NIA <br /> e. Rinsate Hauler and permitted Treatment.Storage 8c Disposal Facility: <br /> Howler Name 1) p Hauler Registration # <br /> Addrm _ City Zap <br /> Phone No. ( ► <br /> Permitted Disposal Site <br /> 4 <br />