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I s L <br /> (a) is there a MEBB conaactor's and sobcoQnacm�s quesdommslre on Me or enr,Ias"? NO[I <br /> (b) Is the current certificate of worker's compensation insurance on tile? NO I I <br /> (a) Does the Contractor possess a"Hazardous Substance Removal Certification*? NO I 1 <br />' (d) Has everyone on sits„Including cranelbackhos operator,been certified <br /> to Work on hazardous waste site in accordance with CCB Two S? NO[] <br />' 2. Haa a"Site Health&Safety Pias"for this Job site been submitted? YES)( NO I 1 <br /> 3. Haq VPUC=t performing removal In the City of obtained a" and Enavation " <br /> Tracy Grading Permit ? <br /> NIA YES I NO[] If YES. Permit p <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NOM I NO(I <br />' 5. is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES(I N 0)( <br /> If tank residual exISM Identify transporting hazardous waste hauler. <br /> Name - KLLE EJ-4 Z Hauler Recon d <br />' Address <br />' Phone Oo 4645 <br /> 7. Decontamination Procedures <br /> a. Will tanks)and piping be decontaminated prior to removal? YES E 1 NO(I <br /> b. Identify contractor performing decontamination <br />' Name= V - <br />' Address� b _. �\n��c�[�\ City SSCb C..1S nl?1p g 5? U5 <br /> Phone No4 ?_ <br />' c. Describe method to be used for decontamination+ <br /> 1V <br />' d. Describe bow Ansate material Will be stored onsite prior to manifesting offsite: <br />' e. Rlmmm Hagler andermitte <br /> p d Treatment.Storage&Disposal FacWty: <br />' Hauler Name - TKL Hauler Registration f <br /> Address ia. p, boy, 14 O city E L)J�1 zlp 5 3 5 <br />' Phone No.( $00 ) - <br /> Na. uS iZ� PSL %F-RV r-e O1 L \ C - <br />' Permitted Disposal <br /> Ell 23 046 (Revised 10119198) Page 4 <br />