Laserfiche WebLink
1L/117/zut7L 1T7: dIj zUtl4btld4dd h1F IH 1'LUUK <br /> 1, (a) is there a PHS.EHD enutraetar S[tad subcontractor's quesuannalre all file or euclosed7 YES 11 NO <br /> (b) is the current certificate of worker's compensation Insurance on Ule7 YEBA NO[1 <br /> (c) Does the contractor possess a'Heaardo0s Substance Removal Certtficatfon'7 YES[(j, NO() <br /> (d) Has everyone an site.Iacludlng atanelbackhoe operator,been eertffied <br /> to work as hazardaus waste site in accordance with CCR Title 97 YESK NO[1 <br /> 2 Hu a'Site Health&Safety Plan"for this job site been submit ted7 YES NO[J <br /> S. Has app0cant performing removal in the City a rracy abtabled a"Grading and Hxravailon Parmlr^7 <br /> NIAP, YES11 NOH if YES,'PermitR___ <br /> 4. Has the caortaiter obtained approval from the local fire department to perform task euttmg?NA4 YES(1 Na11 <br /> S. Is there knowledge or evidence of leakage from the tanks)andlor piping? Of yes,please explain)YES(1 No(It <br /> H. If tank residual erdsts,identify transporting hazardous waste hauler. 4$ 6522,�Z <br /> CAD 3 <br /> Name JaI'je.rsa'k &Vk4z0�r%rneI^ `aA ppH��auler Registration P a - <br /> Address y10( I/jdVSTrleJ Wo" Clty CY.IIIGrC Zip it{J`ID <br /> Phone B( <br /> 7. DeeontaminatlonProeedures: <br /> a_ Will tank(s)and piping be decoaraminated prior to removal? YES it No 1) <br /> h Identify contractor performing decantaorination: <br /> Name t)(itJc/50.1G�llvnrm✓�t � � <br /> Address u 101 l.v)L'5 city 8'—Awc& an <br /> Phone No{ ZOO _]_- <br /> C. Describe method to be used for decoutamlaation: <br /> �tr4n w It 6r RINsrr)vsll21 L+ort.tttrrarcas��c we sir r t�Gkr9rnr. <br /> Rt��GS Ta Qan, c <br /> d Describe how rinsate material will be stored auslte prior tomanifestingoffslte: <br /> IN Ud-c-t� tp lr_ - Ver <br /> e. R(nsateHauler and permitted Treatment,Storage&Disposal Pardllty. � <br /> Hauler Name Ur r Ve"rSal �n�t 12anmutirr,.l Bawer RA&Uadenit CA yL Q <br /> Address q 10 `AJC�USrPU!I L.)A city 'eem tGt 4 ZIp ItA 51 Z) <br /> Phone Na( j0-� ) -7q I b�,q Q <br /> Permlurd Msposal Sit. RarnV� 4/LUIR-pVtVrir�/t17",� <br /> KH230 G (ItavUed08113M) Page <br /> 12/10/02 TUE 09:43 [T%/R% NO 87091 0 003 <br />