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5-27-04; 8:43AM; ;925 551 7888 # 26/ 34 <br /> 0310512004 13:59 2094683433 FIFTH FLOOR PAGE 08 <br /> I Is a aBIS-EHA contractor's and svbeoatcaetor's(a) finer qWtionnalrd,on flie or enclosed? Ips(l Nall <br /> (b)Is the curreat cordlicate of worker`s compensation insurance as tile? YES j 1 pip 11 <br /> (e)Does the conuractorpossess a"Nszardalls SubstaaceRemov$f Q eatice? Y S11. NOB <br /> (d)His everyone on site,Including cranelbackboa operator,been certified <br /> to work an hazardous waste site is accordance with CUR Titie 84 YES 1l No l l <br /> 2. Has a"Sits 9eaith&Safety Ph n"for Ws job site been Submitted? YESU Na t1 <br /> 3. Hasapplieaac performing removal In the Gity of Tracy obtained a"G,radiIIg�sad]3�ccaystiaa Permit"? <br /> WAXYIS11 No r l if YEB, Permit f <br /> 4. His the contractor obtained approval from the local Are departxnent to perform tank caYttiug?NAj j Y63jj NO[j <br /> 5. is Were kmawledge or evidence of leakaga from the tatlk(s)andlorpiping?(9 yes,please explain)YES t1 N0X <br /> G. it tank residual exists,ideafifjrtrairsparting hazardous waste haWar.. 160 , <br /> Na A1rl EaalerBeaietraton G `T/24dllCgo <br /> Address gs /n _ <br /> &22 �C ftp �Y�.7D3 <br /> Picone#(�•��) <br /> 7. DematamivatioaPiocedmes: <br /> F. <br /> a. Wtil tanks)and pl&gbe decontaminated prior to removal? YOS O No l l <br /> b. Identify contractor performing decot<tamlaatlan: <br /> t <br /> Address 4.605 ae(C&eo HlFf ci Co�c�f-W <br /> w�c <br /> Phone No.( <br /> C Describe method to be used for deeontaminatlon: <br /> fi <br /> -v 1 .. <br /> d. Describe l lw riusate materialwiil be stared unsure prior to manifesting offsite: i+ <br /> e. Wmate Hauler and permittedTreatmon4 8torago&Disposal Facility: t�� <br /> vv� <br /> Hauler Name 6l(1 lJ �� , � •�. EastlerAegstxatfanI1071, <br /> CV <br /> Address C;r d I city <br /> Phone No, <br /> Permitted UlaposalSite <br /> BH'23 046evised 08(x3/99 Page 4 <br /> (R ) <br />