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i <br /> • C NA YFS � NCS I I <br /> l h there a contractors quesliannaire on fit ? <br /> a) is she questlonnalre enclosed? <br /> YES + J NO �;I <br /> b) It the currenl cerllticala of worker's compensailon lusurauc.e on fit(,? VIES J;J NO I <br /> c) Does contractor possess a 'llazardous Substance Ren3ovrl Actions Cert '? NA VIES 11011 <br /> 1 'Sil• health & Safety Plan' far this Job site been submitted? YFS Nil ) <br /> 3 Has Applicant perfarmlas removal !n the City of Traty obtulned a "tif udlcig wid Lxcnrullu,i Peewit'? <br /> NIA K 'YRs I I N0 I I if YES, Perurit <br /> d flava lank(*) or piping pendlug jenjor awruked In the 11461? <br /> 5 What will be the disposition of the lank($)/plplug? , }P t ec c c xi• c t u <br /> �lI-inlr-wi11- s--r1�.1�-l�c��._1_�l.!_!1�[.-.�_4-�� -- <br /> aa <br /> 6 Ila$ the contractor obtained approval [ram the local fire deparinIenl to perform id+cic cuuieg? NAI J YkSI j NnJ I <br /> • DecoulantipaIloll Procedures. <br /> a Identify contraclor performla decanianllnallon <br /> Nacos Jia iBec man F " .a. tZlch- Mart C'anat CU( t 9ril^0'i57= <br /> Address x Cif <br /> Phone No <br /> b Will tank( ) piping s andbe detoutanrinated? YES JxI "Cl I I <br /> C pescribe mcthod used to clean Ialuk(s) and/mfll�`g+(IllQl� i t1'lrlC1c:�l'f i+)+'='� c'c� 'rte i'y <br /> `i'lle tank 0s) anti assocloLeci 1-111)i <br /> C - r ns . can r;g prate ►tre M I cans t__t('I ht;ee`(Ty- <br /> C-- <br /> pnses w s eam or o wa er. tnsa a procedure is on fy a in ynutr office, <br /> d Describe how rinsale mawflai will be stored oa sire prior la manifc.sli,►g offsuc <br /> klarilec.--Et�151-r�Luu�iruul,er�..-1hfi�------- <br /> ��r�uE���ici <br /> $ State Registered Hazardous Waste Ifauler* and kermfued Disposal FatillliL's <br /> a, Reslduafl}[azardouoWaste I laL le o le <br /> ra <br /> NaMe o _[; <br /> Address o &5 3 b <br /> City a Ilaulrr Reglsle utiun a CAD 98241 255 <br /> Phone No (__goo_1 3'32-8 10 <br /> Page 4 <br />