REMOVAL_1998 - Laserfiche WebLink

Home Browse Search

1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES V] NO [ ] (b) Is the current certificate of worker's compensation insurance on tile? YES [A NO [ ] (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES LA NO [ ] (d) Has everyone on site, including crane/backhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES NO [ ] 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES pQ NO [ ] 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? N/A f4 YES [ ] NO I ] If YES, Permit # 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NODq 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ j NO K 6. If tank residual exists, identify transporting hazardous waste hauler. Name Nal' C41 0,11 Hauler Registration # 2 N I Address P.O . Box 6city DAna]r zip99316 Phone # ( % 08 ) 332 - `a710 7. Decontamination Procedures: a. Will tank(s) and piping be decontaminated prior to removal? YES K NO [ ] b. Identify contractor performing decontamination: Name Adyawct z +0 Fm VI rt7N mim7-0 To - Address c100 5 N• w), I SO tt Iva t/ City 51 aC 1' b L __ Zip ` 5w5 Phone No.( )-09 N �7 - 1006 C. Describe method to be used for decontamination: 5T'aw clan d. Describe how rinsate material will be stored onsite prior to manifesting offsite: Qti n5•a)� will b� putt;+d ouT of U5T5 by I;C+ar+cf kau�+y e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: , Hauler Name War CQ I '01 I Hauler Registration # "1 Address P• 0. Vol 6 '1 1City P-0 "601- zip Q5306 Phone No. ( 500 1 3V - $ 7 l Nwj,'; c1,cw Z"( / P•rm�T NV098).9�$443 Permitted Disposal Site i • ` 5/20 EH 23 046 (Revised 9/11/96) Page 4