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Emirottmental Health Department i <br /> i <br /> i <br /> 1. (a) lathe current certificateefworker's compensation insurance an file? YES NO ( ] <br /> (b) Does the contractor possess a "Hazardous Substance Removal Certification"? YES N [ 1 i <br /> (c) Has everyone on site, Including cranelbackhoa operator, been certified to work on NO [ ] i <br /> hazardous waste sites in accordance with CCR Tide 8? <br /> 2. <br /> Has a 'lane Health & Oaf* Planfor thialobaltebeen submitted? YES NO [] � <br /> 3. He aplloantperfonning removal in the City ofTmty obtained a p Grading and Excavatlon vennir? { <br /> NIA YES 11 NO [ ] if YES, Permit# <br /> 4* Has the contractor obtained approval from the local fire department to perform tank cutting? NN4 YES [ ] NO ( ] <br /> 5, is then: knowledge or evidence of laskagefrom thetan*) andtor piping? (ifyes, please explain_)y YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler: <br /> Wr <br /> Name � �� /iZ.n fq , — f--7d l Won <br /> HaulerRegistratlon # <br /> Address f � mmmCity Zlp .. <br /> 7. Decontamination Praoeduraw- <br /> a Will tanks) and piping be decontaminated priorto removal? YES NO [ l <br /> b. identify contracborpsrfonningdecontamination: <br /> Name J .r/ _ ic � <br /> Address to X .3— !57City ff Zip <br /> Phone No. <br /> 2 !� 4! ) � t " � Z: <br /> -----r— <br /> a. Descdbernathodtobeused fordecanFaminatlo , f!'Gf k���t1 s f Ef fel <br /> g .� &P 1&J <br /> & DAsafts how OnDats material will a sto d�tnsita 05 <br /> to manifests 9 tez Z <br /> '' F i <br /> e: Rinsat a Hauler and permifttl Treatment; Storage & Disposal FactiiUr_ <br /> i <br /> HeulerName ��� ���ii�riG�aF i��l�... IiaulerRegistreHan #��._.._,�'� <br /> E <br /> AddressJl V��+ C 3 City As eW zip j <br /> i <br /> �eftn ed Dlsposal Sne " �l ErV� <br /> s. a. ldth rps ° ii(awl ecy ize to a d ��etank e <br /> t <br /> b. TenklPiping Hauler. <br /> Name2?,A 4014 -OA!e ► i <br /> Addm q, ,� ?i /^ -- CRY 1 <br /> Phone No; �� f } a ��, 7.:r - <br /> G <br /> t•IautarRegistration # (if hauled ashazardous) . . . -' 1� ' .• <br /> f <br /> i <br /> r <br /> OF10 ' <br />