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ucr- co ua 11 : 1aa imii tnvironmenzai buszem ttl1b) aoa-lull p. J <br /> is there a PRS-END contractors and subcontractaes questlo on Me or enclosed? <br /> (b) Is the current certificate of worker's compensarion insurmwo on tile? TM I 1 Noll <br /> (c) Does the contractor Passau a" ua Substance YES 11 No l l <br /> Bamoval Certlfitxdoaa"t <br /> (d) Has everyone on alto.including craaelbackboe operator,been certltled I 1 Noll <br /> I <br /> to work on hazardous waste site In accordance with CCR Title 87 YES(1 Noll <br /> Y. Bas a"Sits Hea1t>s A Bataty Plea"for this job alto ben suhmitted? YES N"'No <br /> 3. Has applicant performing removal in the City of Tiacy obtained a" <br /> Qraftg WA t I YES I I NO 11 If YES, Permit E and ®atloa t <br /> 4. Has the contractor Obtained approval from the local tie deparQnent to perform tank catling?NA[1 YES(1 No[1 <br /> S- Is there knowledge or evidence of leakage from theUnXs)andfor pt ABT (If)es,please explain)YES t1 NO l l <br /> 8. <br /> It tank residual axis <br /> m.identity transporting haurdona waste healer. <br /> Name EGZ' <br /> Muder loghtmtlon#-(!A D 18Z,03 0 1-4-3 <br /> AddressZS$ fArr' a City PL,"-caK Zip 8 <br /> Phones( <br /> 7. DBOORCOMIMULCIOU Procadau: <br /> a. Will mss)and piping be decontaminated prior to removal? <br /> YISN Noll <br /> b. ldeatily contractor performing decontamination: <br /> Name EC E, <br /> 1 Address 25-5- f err (��v� City IC I wto&IZIa 9 t(QO l <br /> Phone No.( $1 D ) Z 3 S`- 13 13 I C CJ <br /> L Describe Fot4d to be used for do p.nuzdqatlo . rr e l` <br /> r o 1 o, re t -Fu w �er ftssUft wd-skcf k Oto�t�fa0a�� <br /> r' ` roM9a rc usr t VAG � � <br /> ve <br /> d. Descrlbs how riusste material will be red o sits prior m es <br /> ting otislts: <br /> ® � vwc,,,,►K Ar v t.k. <br /> e• Blaaats Hauler and Pepelpod Treatment.Storage A Disposal rugW <br /> ECI - "..terGWMII <br /> Nan:eDOs s,1- Tawti t: ��ew+teal Carte ,280muzzlon 0 CAbW ySZ C3� <br /> Addreaa_ nos i lzcity o zip R Y 30 3 <br /> Phone No. f( Sp a 3z 4 - 1639 <br /> PacmitcadDia Stte CroglY ( ,Cr" L. ' c A. 1630 (.Jos l6 5�. <br /> EB 23 046 *vued W13pA Page 4 <br /> 10/25/01 THU 10:14 [TX/RX NO 87481 Ij003 <br />