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SEP OT '99 14:11 FROW I C E S T-619 P.03/06 F-248 <br /> I <br /> wn=Mr.s eu quasttonnatzs an Sle cr tadased? N 0 M <br /> 1• {ay is tttera a tas•r�l �41 1� <br /> r {by Is <br /> the currant cartitiesta of Worker's c=paasatiou iasaran"on Nal �s.Ml J Nall <br /> (c) Does We coatt;ctar gvoaess a►"Harardaoa 8ubataaee!��Cerdiicatloa"7 <br /> (d) fias everyone an and,lar3udlag cranelbackhoe aparztor.been entttAed YZ .V!J NO <br /> 11 <br /> to wont ou u=maus wasw alta in aasardaaae wUh CCB Tina 87 <br /> YHs M <br /> 2 Bas a"Site Health&Safety p" for this yob site been su4mlttad? <br /> NO�j <br /> g, Has plicaat perto�g removal In ma stty at Tracy obraiued a"6radlag <br /> and&Yeavatian Permit"7 <br /> NIAIT U311 NC t 1 u YES, Permit# <br /> @za Lite cantrattor obtained approval from the lova!"deparauoat to pertarm taAX cutting?XA[/ Vq i NQ[1 <br /> g. is there imawledge or evidence of leakage iram the tanit(s)an4lor gtpiug? (Lt Ye$,;Ie rspfafal YES{] No 11 <br /> 8. if teak residual ensu,1011 fy trsMorging hazardous w&sts fouler. <br /> yy lfa s.�! Sattler gegiarradoaF <br /> dame -f� II s u i rte. i5(Q Clry Tte r I v c�• Zip 5 31,E <br /> Address Z.g3D CTc <br /> 7. )}aaautamlatdoA Praaedar'ea: <br /> a W taargs)and plptng be decouta minsUd prior to removal? IE3 NO{] <br /> ` <br /> b, identify contractor perforutln9 d15conta fm-inadOm <br /> Name Co�s#vU GT c h <br /> CIO. �{ F <br /> Addraaa 313 rw Y *Z0j City CDISt�i � J ZID 9 5 ` <br /> Mae Na j p <br /> c, Describe me w1 be used for decontamination:`� i ✓ Y <br /> ar tS <br /> d. flescrtga ovt rlasau marnrfal bo scared easita priartc les#tsg of[�ZaT ✓ <br /> Iillsk <br /> VIA A <br /> k <br /> e_ 8iusate Hauler mad permitted Treatment.Storage&USTMal Facllitr <br /> Hauler Name !•4 >ZsaIer leagistrstiaa 37�} <br /> Address Z`�3 a tA`t�y ,s'"� `• ZIP °l5315� <br /> Phone No.L-2 00 <br /> FermltsedDleposalSite fT NSTrI VI�a� <br /> M 23 Ga Vtevised MIMI&) ice; <br />