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v <br />yss� Moll <br />1 (a) is there a PHS•EHD contractor's and sabcan� lane gin strda a an tl1eTUsura on file or enclosedT YES K Not] <br />o]] <br />LIa the aturent certificate of Wot''ser's aampe ygg Na [ j <br />(r) Does the aontraetor possessa' Havar'dadv Substance Removal Certification"? <br />(d) Ru avet7one an site, including cramibactitoe Operator, been csrrified Yh'S No i 1 <br />to Wo't on haaardous waste site in accordance with CCH Title 3? <br />YES xo[] <br />2 Has a ' Site Health 6 3atets plan" ter this Job site been submitxedT <br />[� <br />? Has applicant perfarmtng removal in the City of Trac' obtained a " a&and °..ac v04 Permit"? <br />YES ND [ 1 it YES, Permit d L&ge3g=l O <br />1 Has the contractor obtalud apereval trom the local fire department to perform tank =WW No] ] <br />;, is there imawledge or evidence of leakage frac the tangs) s &ar pip1129? tit yes, please explain) <br />g, it cant residualldeu 1f? transporting hatardona waste hauler. 3-7qq J <br />AVW[�pM-v� Waste Oil Haulers <br />Noma Harder de8fstranan <br />Address <br />P.O. Box 645 L'ttyDenair, CA an 95316 <br />Phone #( 800 � 322-8710 <br />Deccntara nation Procedures <br />a. Q'ill rantds) and pipinE be decontaminated pylar to ramooalT <br />YES[ NDI] <br />b.Identitl can tractor perflrming decantaminados <br />Name Jim Thorpe Oil, Inc. <br />9.daress <br />P.O. Box 357 City Lodi, CA RV 95241-0357 <br />phone14 2t 09� 368-6175 <br />Describe method to be deed for dea0ntSminartOM <br />m <br />will l�ri pl p ri n¢anjxTith hi Ijag r n AaoY.l c p <br />manner. <br />�. Describe how rtasate material wDi be stored onsite prior to manlfestlng offsite: <br />frnm the <br />es as <br />his <br />they are bei ri b e <br />truck, or be stored in seasplledsadpru until it can be disposed of. <br />svx <br />HinHauler and permitted Treatment. Starag <br />Ranier Name Same as #6 flamer Negis.'*atton Y <br />Add: css <br />C[ty �— zp <br />Phoae Yo. ! <br />Perini ted Disposal Stte <br />Aericlean, Inc. 2570 Almond Dr. Silver Springs <br />NV.mor other approved facility. <br />EE 23 c•;s (Revised Daii3i9S) <br />Pages <br />