Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation insurance on file? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(d) Has everyone on site, including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? <br />3. <br />4. <br />5. <br />6. <br />7 <br />W <br />YES [ <br />NO [ I <br />YES <br />NO [ ] <br />YES [$ <br />NO [ ] <br />YES [A NO [ I <br />YES [ J NO [ ] <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A j ] YES [ ] NO [ [ If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[)d YES[ ] NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO N <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name Allied Petroleum Hauler Registration # 1158 <br />Address PO Box 193 City Modesto Zip 95352 <br />Phone #( 209 ) 576-8500 <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES Lt] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name <br />Address 1217 S. 7th St. City Modesto Zip 95351 <br />Phone No.( 209 ) 524-9653 <br />C. Describe method to be used for decontamination: <br />The tanks & piping will be triple rinsed at 1800 using a low volume, high <br />pressure washer. The first rinse will include the use of a bio degradable <br />detergent. The two final rinses will be clean crater. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />The rinsate material will be stored on site in DOT 55 gallon drums with <br />appropriate labels. <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name Allied Petroleum Hauler Registration # 1158 <br />Address PO Aox 193 CitV Modesto Zip 95352 <br />Phone No.( 209 ) 576-3500 <br />Permitted Disposal Site Ameri cl an - ri leer Springs. NV <br />EH 23 046 (Revised 7/10/96) Page 4 <br />