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1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES lr] NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES W NO ( ] <br /> (c) Does the contractor Possess a "Hazardous Substance Removal Certification". YES X CO <br /> (d) Has everyone on site, inciuding crane�backhoe operator, been certified <br /> to wort: on hazardous waste site in accordance with CCR Title 8? YES'5? NO [ ] <br /> Has a "Site Health & Safety Plan,, for this job site been submitted'. YES ( ] NO <br /> Has aoplic :ane peorming removal in the City of ski'? obtained a "Grading and Excavation Permit"? <br /> N/P X, YES ( 1 NO ( ] If YES. Permit <br /> Has the contractor obtained aoproval from the local fire deparment to perform rank cutting'. tin( [ Y=S[ ( NOP� <br /> _. Is there knowiedge or evidence of leakage from the tank(s) and/ Dining'. (If yoes� please explain) YES [ 1 tiOX <br /> T2 IA 5 S P - i 2 � �! �>>cu Z_i �9D <br /> e. <br /> o. If rank residual ezisu. identify transporting hazardous waste hauler: CSD 9 yam , 17LS-y— <br /> `�7 CQ-� Hauler Reg /� <br /> istration r `/,C dol 1(0.2 '90 F' <br /> Name /�' OV' <br /> -Address P-0, /7� o >s G y Circ De 'MC. i r Zip <br /> Phone = ( $6 0 1 3 - 5- 71 0 <br /> Decontamination Proczdum. <br /> _ <br /> a. Williil cnnkis) and piping be decontaminated prm YE <br /> or removal? c <br /> b. Identify contractor performing decanramination: <br /> Name t1Z11 <br /> Address X53 S W ti�-� hin'y�• �/1 • Cir. Zip <br /> / X <br /> Phone No.i�� 337_ <br /> Describe method to be a for de-con tamia 'on: E.w�- ! �`�1ff.� 4• <br /> �,����� hrns a •^��e.^.ai ill he toted onsite Pror -o ma iestin: otzsit : <br /> _. <br /> e, Rinsace Hauler and permitted Treatment, Storage & Disposal Faciirr: <br /> i <br /> Hauler Name �- i e ci n ✓cele � y.Hanler Re•,:3�tion m Z�_ <br /> -- 'i>7 <br /> .address <br /> 'x`730 %SwCity !uv-/Oc /t _zlp 4 38 <br /> Phone Ya• <br /> 1 d GL <br /> Permitted Disposal Site A <br /> S/ZO <br /> EH 3.3 046 (Revised 9/11196) Page 4 <br />