Laserfiche WebLink
v <br /> 1. (a) Is there a PHS.EHD contractor's and subcontractor's questionnalre on file or enclosed? YESM NO[J <br /> (b) Is the current certificate of worker's compensation Insurance on file? YESM NO[I <br /> (c) Does the contractor possess a"Hazardotm Substance Removal Certification"? YES K NO[) <br /> (d) Has everyone on site,Including cranetbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 87 YES$, NO[J <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YESX NO[J <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAX YES I I NO[I If YES, Permit 8 <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NAXUS[I NO[1 <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[J NO JJj' <br /> 6. If tank residual exists, <br /> Identify r. <br /> transporting hazardous waste hauler. <br /> Name / ,In .5 < r15��LCJi Hauler Registration/ <br /> Address JCQ(o �e7_ 1-9-147M/LW d/' A ZIP <br /> 7. Decontamination Procedures: <br /> a Will tanks)and piping be decontaminated prior to removal? YESX NO[[ <br /> b. Identify contractor performing decontamination: <br /> Name /7�,gmi�I j� 5!�5 /I /� <br /> Address �f/ �0��✓Lg CitylaC ,A ZIpJ�� <br /> i <br /> Phone No.(_6/Q ) <br /> C, Describe method to be used for decontamination: _ <br /> d. Describe bow rinsate material will be tored ouslte prior to maulfesting offsite: <br /> e. Rbtsate�Hauler and <br /> "peeermitted Treatment,Storage&Disposal Facility. <br /> Hauler Name /a/y�1L5 ,L�1��_Hauler Registration 0 p <br /> Address #n& /4�Q �Lf3- city�zjp lp Q'2ql� <br /> Phone No.2/o ) <br /> Permitted Disposal Site ��i 10/yh/,QQD� �rgTO,eee Sot <br /> RH 23 046 (Revised 08113199) Page 4 <br />