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' Ur 11 <br /> i. (a) le there a PHS gH0 contra and sabcontracmr's questionnaire on the or enclosed? YES F1 NO <br /> ES Jd NO(I <br /> (b) is the current certificate of worker's compensatlan a Removacill <br /> C raft1110? E9 NO <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certlflcatloo°T M {I <br /> (d) Has everyone on site,including emalbackhoe operator.been certified T&S NO I I <br /> to work on hazardous waste site IN aeeardancs with CCR Title ST <br /> 2. Hae a"Site Health&Safety Plan"for this Job site been submitted? <br /> YESII NO FI <br /> 3. Has applicant performing removalin the City <br /> YRS, Permit obtained a"Grading am Rscavation Permit"? <br /> NIA b( M11 [I if <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cuttlag?NA(I Y¢SM NO(] <br /> S. is there knowledge or evidence of leakage from the tanks)and/or Piping? (if yes,please explain)ES I I NODI <br /> S. If tank residual exdsts.Identify tranaportlng hazardous waste hauler. <br /> Name Rn - Hauler aeglstratlonA cps ozaa7?o3& <br /> Address X313 5n �Lti It J x✓ Qd al Clfy S�crarnl4. Ztp 4544 — <br /> Phone I 9 it, ni- s <br /> 7. Decontamination Procedures: <br /> s. Will tank(s)and piping be decontaminated prior to removal? YF•S M NO l I <br /> b. identify contractor performing decontamination: <br /> Name P: C•a+ ,4 re« <br /> Address ? 0 tic< <br /> Phone No.L S <br /> c. Describe method to be used for decontaminstloa: <br /> r 1n " and A.2rnn e + N. <br /> s Jaw<. i <br /> �IGr'ik---- <br /> d. Describe how ansate material will be stored enalte prior to manifesting offsite: <br /> 1 be <br /> e. Rlmate Hauler and permitted Treatment,Storage&Disposal Facility' <br /> Hauler Name Ro. *5 HaalerReglstratlonM ciao o�6A�7o3[ <br /> Address t5iS 90 4n Rcaig City wcsk Zip <br /> PhoneNo.( 3 (4 1 488 -59S- <br /> Permitted Disposal Site C A 0 O gYo 3 Ss A — <br /> ®23 046 (Revised 10119196) Page 4 <br />