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M <br />2. <br />3. <br />4. <br />5. <br />J, <br />7. <br />(a) Is there n PIIS-EIID contractor's questlonnnire on file or enclosed? Yl.-SNO <br />71 <br />(b) Is the current certificate of workers compensnflon litsin-vince on rile? Yr.—S] No <br />(c) Does the contractor possess a "lla7Awilotin 810KIneve Certifirnflon-? Y Eq No <br />Has a 'Site Health & Safety Irian* For this Job site brewt sishmiffefl? I. l?q V1 No I I <br />IIn.q applicant performing removnl in the City O(Ttncy o1411111"I R "Gindivil! and FT.cR9:1f;ot1 T'ermlt'? <br />N/Ajj Yrs [ ] NO t I If YES, Pel."111 ff <br />IIns the cotitinctor ob(nined approval 6-0111 the 11pripi rile (IC11110ment to lice rmin InIlk viffbig? NA[ 1 yl?q[ j r,100 <br />Is there knowledge or evidence or lenkage rrom floe (nnk(s) and/or piping? (jr yes, pien.;r vii's I I NO �1 <br />If tank residual exists, identity transporting lin-Yni-dofis wnste liniller- <br />Name Ilnulrr RrZislyntion ff-f <br />AddrcssE��— S. �,J U A c AV i -P!,111 <br />phone <br />Deiront.nminntion rrocedum-s: <br />n. Will tnnk(s) and piping be deconinmin"fed pr ion to Trilloyni? <br />b. Identity contrnctor perrormbig decontninlyintlom <br />Al o vuyv <br />Name <br />Address City, Zip <br />Phone No. CZ1—r-Lj <br />C. Describe method to be used For deconta 1111intion: <br />1,% . --I P . " A . I <br />d. Describe hiyInsate rterInI will he stored onsite ptlor to "Innifesting offsite: <br />e. Rinsnte Hauler and permitted Treatment, Stornge & DIsposnI Fncili(y- <br />Hauler Y OYA Yf r- 1,14- linuler Registration #(? <br />Addressp—j—,)L <br />Phone rJo. (.a <br />Permitted Disposal Site = <br />F Y-\, T7- J A <br />V <br />i'rlgeA <br />