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____ ri�,`a.' t - •'.*•�.•u ..v .ri ^'7. - i.v:, - _:ai�...._._.._•a..� {i,i='eil�*.�vr <br /> ..-L (s) Is there:PHS-E®co�atcicba�'s ; . „:r _^� w y <br /> a :- oa fle osed? YES . - <br /> ware or , <br /> and , a NO t <br /> (b) Is the aatreat certificate os worlxr's <br /> empensation lasaianx on Ble? YES K NO <br /> Don j] <br /> (c) Dothe Contractor .- - - <br /> P a W=M*ns Removal ca oa-? YES ] NO <br /> 2. Has a ate Health do Sxh*Y PW for this job site bees sab=jtted? <br /> YES fie( NO t 1 <br /> 3. Has aPPUmut PalbrininE removal is the cur of Tracy obtained a-Grrad'wc and Enation Permit'? <br /> NIA YES I 1 NO [] It YES, Permit#— <br /> 4. Sas the contractor obtained approved from•the local Bre department to Perfk=tank cutdne. NA((YES[1 NO[1 <br /> 3. Is there knowbfte <br /> or evideaa of from the . .an _.._.._... _ ._.::. <br /> taak(s) d/or piping?-'*- les.please- <br /> YES NO t] <br /> U e,-.A Jiln C /(l /O1,I� 'STN I rlL. G <br /> G. If tank resaimd eXIsta Idmfir trate buardoux waste b=lec: <br /> Name NrA Hammer BeglslraGaan <br /> Address C, Zip <br /> Phone# ( 1 <br /> w - <br /> 7. __ Procedm= <br /> a. WM tsnk(s) and piping be dxoabamiaated prior to removal? =)I NO <br /> b. Identlfy Contractor pedbrming decontamfnatiom <br /> Address 4 LLo Qbwn M f z e%&L �'_S _city1 RSA c.�. e A Zip <br /> Phare Nat <br /> c. Desna soetltod to be used Boa decootamiaatloem <br /> Pas E %A, -taw waTE R Carve 5 o A e'er <br /> d. Deseadbe Low timate mahaW wm be.:taeed aoslte pejo to o�c . <br /> APi�tZ4 i��? ATB D15 AOSA1� • <br /> e. Riasste Hanle!and pemimed T Stot+.w &Disposal FacMty: <br /> HsaName £iv v tZo Ov iZ VJ E5 r Hamlet Bin# (.O 3 Z 17 <br /> _— - <br /> Address �- Cuy ;�A wi;L .,s�'A zip 9s33 <br /> b <br /> 3 <br /> Phage Na t” 8_O_l8 el 4 4 4 4 4 <br /> Pztmitted <br /> ss. •, t: Ze. z_... <br /> NOW <br /> a l •+✓tiui ..� - t r y rte•• -- <br />