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Mar-22-05 10:45am From-Gettler-Rya- 'nc +9166311317 T-636 P.002/008 F-334 <br /> (b) Is the current certificate of worker's compensation insurance en file? YESM' NO[] <br /> (c) Does the contractor possess a"Ha:rard ius Substance Removal Certification"? YES,K NO(] <br /> (d) Has everyone on site,including crane,'backhoe operator,been certified to work on <br /> (e) hazardous waste site in accordan:e wi th CCR Title 87 YES,[ NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES N NOH <br /> ] <br /> e57catia—j <br /> 3. Has applicant performing removal in i:he Cit} of Txuppobtained a "Gradingand ExcavationQ�1'��cV�a <br /> N/A[] YES[] NO[l if YES, Permit# r r�� <br /> 4. Has the contractor obtained approval fron i the Iocal fire departmi-T.t to perform tank cutting-NA <br /> (�YfiS(]NO[] <br /> 5, Is there knowledge or evidence of leakage frc:rn the tanl<(s)and/cr piping? (If yes,please explain)`YES[] NO[] <br /> U Fjk,L)6 <br /> 6. If tank residual exists,identify transpc,rtin3 hazardous waste hau'e:: '9E'FWr?_ -Th A 177Xe- f&7> &f -0- L&M <br /> Feeor+ A-04 f 5 Sty w-WI OSdf <br /> Name Hauler Registration# <br /> Address--_ cit l- Zip <br /> Phone# <br /> 7. Decontamination Procedures: ATrA•:.Nc�j w.5,2r, i_&7r-e_ ;W.`"" 0+0 <br /> a. Will tank(s)and piping be deconti ninated prior to remo-21? YES[] NO[] <br /> b. Identify contractor performiuG de_oni..amination: <br /> Name — - <br /> Address City- Zip <br /> Phone No.( ) —._.. - <br /> c. Describe method to be used far de contamination: <br /> �Tta �t"IT141".1=�_�' ,I]�42L-1~L-rM-YL 1�=r4,�-� /�-D S SCS//CCS. i►rC, <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> ��� 'T�' ATTAt'�!�� 1,,,9a2t� 4•�t7�.-�y+*�^ �pg+s75 .St�eyicas,.L.�G_ <br /> e. Rinsate Hauler and permittee/TreZhment,Storas;e&Dispoeal Facility: F.�., a� os� r <br /> Hauler Name _Kj%j ce,sr a C-._ _Hauler Registration# 3 Z 1(d <br /> Address 4th G�, sa NOn.i t7(',f� ZW D. Cit3 �Aelx-:�Mq. 4A Zip q0 Z4/6 <br /> Phone No. <br /> Permitted Disposal Site�L;;l�1(=ice. t'_. tpQfL' <br /> EH 23 046 (Revised 10116103) Page 4: <br />