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(b) is the current certificate of worker's compensation insurance on file? YES[ NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES[\f NO[] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on <br /> (e) hazardous waste site in accordance with CCR Title 8? YES[4 NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? AnAc.Hf> YES[t�/NO[] <br /> S.:S OQn <br /> 3. Has applicant performing removal in thelEity-ef-�obtained a"Grading and Excavation Permit"? <br /> N/A[] YES[] NO[] If YES, Permit#�A Q&L S ,5caa,.JJ R41WIW. Offl, <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YES[]NO[J <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[] NO[] <br /> A K tib\JJtti <br /> 6. If tank r--;aual exists,identify transporting hazardous waste hauler: 0.EFM To AttAILIAfSb <br /> won.,lpu.rl t_£T7fa. F2oK� AD►.YnS =��it,SS• �►1c. <br /> Name Hauler Registration# <br /> Address City Zip <br /> Phone#( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES S1 NO[] <br /> b. Identify contractor performing decontamination: REFER To A'na6t k1a) wcn.J� PLA,4 ukJTf-t_ <br /> FQ.0M ADAMS SfW-'4J( C, !w(, <br /> Name <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> I lj& To I.TiAc,►►4 �,Q.on.l_ pijkM lAnjp Fzb,% AaAMS SiQV1t-fC IUG <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> VA 1 eu LAr, - <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Uf[a. To WJAMS SERV14AS i»C v,roR-c P"4YL "TM <br /> Hauler Name d ii^Vn< S1Q%/J 9AJ 104c- Hauler Registration# <br /> Address L4 n 6, E. ALA K1bQA %,Vt% CitYGs0.QeN A ZipC11))4 <br /> Phone No. (1,L0 ) 42..3 �I 4 2-S O <br /> Permitted Disposal Site <br /> EH 23 046 (Revised l0/16/03) Page 4 <br />