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04-21-93 11:39AM P05 <br /> 1. (a) Is there a PHt3.EHD contraetoes questionnaire on ale or enclosed? YW ( I NO f 1 <br /> (Bey COVev \Cthr Yoe Mn 1) <br /> (b) L the Current Certificate otworkees compensation baauraata on flit? VW [1 Not] <br /> (See Cm.ar (et{ee :Pie" r) <br /> (e) Das the Contractor pagans a vEbmul o sabotans Resnva Ci rd scatime? YES i I NO 13 <br /> C %,k (aver 1a14rr 7;.ttw.r) <br /> L Has a Vee Smit&fia/et{<Platt•tar this Job she been subutitted? YFts L I NO p( <br /> (gree Covey, ke. 4er 7,4avvl 4) <br /> 3. Hes appllaant pertermini removal in do Cllr of Tracy obtalw l a Vradtnm and j3mcaeadeng PMm4R <br /> NIA)< YMi t 1 NO [1 it YES, Permit sit 1 <br /> 4. Has the contractor obtained approval from the local fire department to perform tank Cutting? NADO Yat I NO[[[I <br /> S. Is there knowledge or evidence of leakage bow the tank(s) madlor piping? (If M piesse explain)77'YFg [I No pq <br /> 6. If tank residual exists, ldtntlo transporting hazmrdoue waste hsult n <br /> Name Bre (Ayer le R" xievv, 1 Hmrkr Rq(stradon R <br /> Address CityZip <br /> Phone N <br /> 7. Dmontammatkm Promdmeer <br /> a. Will tank(&) and piping be derontambtated prior to removal? YF.4)(i NO I I <br /> b. Identify Contractor performing decontaminations <br /> Name See Cpve0, 1etlrr,Uem 1 <br /> Address City UP <br /> Phone No.( 1 <br /> C. Describe method to be used for decontaminations <br /> 7&r d&adjg*ina'Iron iwdfltsd nal/ Jr Ekau adeREr/ dMfeaAcr anal Wal !w <br /> dM ..+fed .ir ortand= ail% M(0Mg%rr j a/ [vtz8• &rd fagfifflat ,&Ar,&17 rr<_ <br /> CL DescrM how Ansate material will be stored onsite Prior to marrifntlng oQsltc <br /> i,_waresorr tRMtelS a&N W &)had er+it73 b Ztu m! r.�.tiba7�r it ' awn e4x <br /> wt r as* adcJl /Au4wr/ teLes%nS - <br /> e Rinsate nudge and pervaina Treatment, Storage&Disposal Faellk?t <br /> Hauler Name Sre 6rt✓ letkr dean i Hauler Registrations 0 <br /> Address Citi Zip <br /> Mae No. { ) <br /> Permitted Disposal Sila <br /> Page 4 <br />