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I � <br />/1. ,(R) Is there a PIIS-Elll) cotetraclor's questionnaire Ott file or enclosed? YES NO } } <br /> y/ (b) Is the current certificate of worker's compensation htateraiux on file? YES' NO } <br /> (c) 1)os tha e eantraclor',posaesa 'rlal, <br /> iardoua Sutelas>,ce Removal c MMICallon"1 YF.3 NO <br /> el ] <br /> .2, line a 'Site Ileaills h Sardy. rUn' for fhis Job site been stab mlficAl YES P1 NO ( ] I <br /> 3. Ilns a llcaul rfortlthtg rentoval let the Cil of'frac ohlalned a 'Gradin and Kx"vallau 11 etmfl'? <br /> pr � si y y � I <br /> N/A y4 YF.3 ( } No I } If YES, 1'crmll:At <br /> 4. Ilan the coneractor obialetcd approval from lite local fire depar.tmeett to perform failk culthtg? NAKYFS( j NQ <br /> 1 <br /> S• Is there knowledge or evidence of ieakage from Hee tanks) mud/or piping? (1f yes, please explufu) YES [ } MO <br /> 6. If funk residual exists, Identify traneporftufj haiardoue waele haulm <br /> Name Nor-Cf-ii WrtsLe ()it hat11(r1•a Ilattler HcglslraHulu N CAI) 90241'x255 <br /> Address P.01. Box 616 (.fly I)ettail•, CA zip 95316 <br /> I'horte * ( 2091 <br /> 1• Decontamination rwvccdurm k <br /> ■. Will tank(s) and,plying be deconlanthealed ptlor to ren)ovel?, �Y.L3 NO } } <br /> bra✓ b. Identify cottfract'lor perfornting decoutamlundont <br /> I <br /> Natne 'Mm •I'hilwiw 011 , laic./ hllA Klett-Pl3rt, Cuis1.1•utt,lon <br /> Address 351 N'{• Ilec;katale rill./ I'.O. Ilex 357 City I.ucll ,CA Zip 95241-0357 <br /> Phone No.( 209 } %2•-4'501 .1'1.01141 : lieu M;tL. harslet• 0 2667 <br /> C. Uescrtbe me(hod, io be d for decontanthtalfoist ' <br /> 011 r <br /> d. 1)cserlbc how On sale mnlerlal will be stored onsllc prlur to numire,Hng orfsltet � <br /> 71tA riltssal.tt.wi I1"t! Olt,Olt, 111c, pel,sotiel alts )laced lu <br /> (lilt slut- Tim d l'im .9 w I l lx-, 1,t�iju.jal2S2j,,Lil by ugj to uuv yal- aL 00*1 Black WamUlnl <br /> Way, loculitt CA to awall. tilde 111) by a (111a111'lell roll lec;Li011 ciNrpimy. EISA #CAL 000012111111 <br /> e. Illnsale Hauler aI td pamilted 'Freafrnenl, Storage do Ulsposal 1+acililyt <br /> Hauler Name S`l'ate as a 6 Hauler Reglslratlo16 <br /> Address City Zip <br /> Phone No. (_ } <br /> f ermilled I)Isp040 Site Refineries Services Pat.Lel•son, CA or ol,hel;. alrl>royed'facilUy. <br /> rage 4 <br /> I I I <br />