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A <br /> f <br /> WAONENGINEERING 91ej*40811 P . 95 <br /> MPR 15 '93 33:19PM ULTRAMRR INC. P•5i16 t <br /> t. <br /> 1. (a) Is there a PHS-EHD coatractar's queetiotmalre on lHe or enciasW? YES X NO [ ] <br /> (b) Is the current certinaate of WorkWS compensation Insurance on Cle? YES PQ NO j ) <br /> (c) Does the contractor possess a -Hassedoaa Saboaoce RcMqW C yon-? YES K NO ( ] <br /> 2. Has a `Site Health ! Sateq Plat' for this job site been submitted? YEA>4 NO [ ) <br /> 3. Has appUcaot performing removal In the City of Tracy obtained a 'Gtydfni and Exatatroo Peradr. <br /> N/A YES ( ] NO ( ] If YES, Permit N ] <br /> q <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA,)4YES( ] NO( ] <br /> S. Is there knowledge or evidence of leakage ?Yom the taek(s) and/or piping? (If yea, please explain) YES [ ] N0� <br /> E <br /> 6. If tank residual exists, Identity transporting hazudous waste hauler. <br /> CAD <br /> Name O.S C R fZ r rc i c V.s o -1�-nI C! Hanky ReAiapvflw dr 009 q(0 6,3 R 1— <br /> Address Z s S PA,r L rL U C_v p Ciq 1Z r c_� c-,. zip 9 F c / <br /> Phone ( 5 f o ) Z 'S S- <br /> 7. Decoutami"don Prowdum <br /> IL Will tank(s) and piping be decontaminated prior to removal? YES K NO [ ] <br /> b. Identity contractor performing decontawl"dont <br /> Name <br /> Address P. 0 c X /o z Z city _LdC S Li�c rc zip _9 r� a i , <br /> PhoneNu.( c7l( 1 -3-+ L — <br /> C. Describe method to be used for decontamination: <br /> (AJ4-7- Eih- f2-.r.( $ C R A-c K t'0 -CLIA rc $ <br /> d. Describe haw rlasate material will be stored onalts prior to manUesting o!lsitp <br /> e. Itinaate Hauler and pscmlteed Treatment, Storage & Disposal Faeillq: <br /> C �9 <br /> Hauler Name S c A,ri- - f5n I c V so.4 S c Hanker Regigtradw # b D 6 3 <br /> Address S a.^IT- A-s A-am yr City � zip <br /> Phone No. ( 1 <br /> Permitted Disposal Site i C,S o.1 C t c_ t, 12. r ,of r N C, C O , <br /> Page 4 <br />