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REMOVAL_1991
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0540518
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REMOVAL_1991
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Entry Properties
Last modified
4/1/2020 11:52:47 AM
Creation date
11/2/2018 4:50:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
1991
RECORD_ID
PR0540518
PE
2381
FACILITY_ID
FA0002547
FACILITY_NAME
QUEEN OF SHEBA #2
STREET_NUMBER
710
Direction
E
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16717002
CURRENT_STATUS
02
SITE_LOCATION
710 E CHARTER WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\C\CHARTER\710\PR0540518\REMOVAL 1991.PDF
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EHD - Public
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1. Is there a contractor's questionnaire on file? NA [ ] YES [ ] NO [ ] <br /> a) Is the questionnaire enclosed? YES [ ] NO [ ] <br /> b) Is the current certificate of worker's compensation insurance on file? YES kj NO [ J <br /> C) Does contractor possess a "Hazardous Substance Removal Actions Cert."? NA [ ] YES [4 NO [ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES �,J NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br /> N/A [ J YES [ j NO [ J If YES, Permit # <br /> 4. Have tank(s) or piping pending removal leaked in the past? YES [ ] NO 61 <br /> 5. What will be the disposition of the tank(s)/piping? <br /> 0.5; Gl/rift' it.�C <br /> 6. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ j YES[ j NO[ j <br /> �/fri-� Com;[� ��/1/o Tom,,,� c'✓m�-5 'mss <br /> 7. Decontamination Procedures: S(//N� T}�ivc /S' hitJcytyny <br /> a. Identify contractor performing decontamination <br /> Name t c <br /> Address City 15 /LHA)Zip 1 <br /> PhoneNo.(() �/oS'ZUUy <br /> b. Will tank(s) and piping be decontaminated? YES ] NO [ j <br /> C. Describe method used to clean tanks) and/or piping (If not in contractor's file): <br /> i �7y1_ <br /> cz <br /> i <br /> d. Describe homey rinsate material will be stored on site prior to manifesting offsite: <br /> /%iyS� L�/iLL hd, 5' 1�17 moi^//� S S 9�tGa..i 9i v�acS <br /> 8. State Registered Hazardous Waste Haulers and Permitted Disposal Facilities. <br /> a. Residual azardous Waste Hauler <br /> Name <br /> AddressU <br /> City Stale zip l Lo/ <br /> Phone No. Z'�' ) l{l�s— Z��r�r1 Hauler Registration # 0-24-&5— <br /> Page <br /> -2.{feyPage 4 <br />
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