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H <br />0 <br />N <br />0 <br />Cm <br />C <br />KI <br />there a p r# i (f contractoesandsubcontractoesquestionnaire 1 1 Me or 1 t i 1:' 1 <br />G thecurrentcertificate, worker's insurance on file?ti �.. 1 <br />Does the contractorpossess . "Hazardous SubstanceRemoval 1. 1 1 C:1 1 <br />f.Has everyoneon site,1 1{ l'cranerbackhoeoperator, 1certified <br />1 work <br />I 1 1 I'.. NOF <br />Has a "Sits Health & Safety " for this job site beensubmitted? NO [ ] <br />Has t pert In the City of obtained a " Excavation Permit"? <br />NIA [ J NO [ ] If= Permit# <br />Has the contractor obtained approval from the local fire department to perform J NO[ J <br />Is there Imowledge or evidence of leakage from the s) andfor pi (If yes, please explain) YES [ J NO <br />IMT,77 1 1. T,74 71,31 ,.! 1. i 1- r 1:: .1' 1P VA:it-(I 1. 'T tj � � 10, kf <br />Nameg C Ranier Registration 0 1 13 <br />G \MWEVEMNIM\ _ s'' .�..► <br />done # i,:-� a aS .— 1 3 2�2 <br />f, 1(' 1 A t i': Procedures: <br />a. NM tanll P and piping '1 decontaminated prior to removal?YESX '< <br />1. Identify f I N 1 performing 11 1 :.r 111 A: :11: <br />Name <br />Address2. S R� LV� city p \r H Vi Nle Zip <br />Phone N04 rr,� \ Q) 2 '7S 5 — 13 a I <br />I' � . - H I::: , 1 "SI'1 : III' 1 1 ,. ,. 1 ', 1:'- f , 1: G I •:. I ' 1 {.: <br />Hauler and permitted Trea Stomp & Disposal Facility: <br />Ranier Name_E—�...... Ranier Registration # <br />city Mp <br />P11r. r, <br />Ell 23 046(Revised10119198) Page 4 <br />