Laserfiche WebLink
*m.. <br />.1� <br />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 />El <br />5. <br />YES NO [ ] <br />YES NO[ ] <br />YES [�j� NO [ ] <br />YES [,r' NO [ ] <br />YES {-r'NO [ ] <br />Hasapp nt performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A r YES [ [ NO [ ] If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[f"YES[ ] NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [l <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name Ji(! V,_FiJ �!1//G2maYfrLHaulcr Registration # �q! y <br />Address �np . u�C �7 �� [� City -Z F+ 1 Zip IS7/s— <br />Phone # (QGU ) <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES LINO [ ] <br />b. Identify contractor performing decontamination: r // r7- <br />NamI f��'l /rCS"i7p�`fi�^�J'� tID p <br />Address�Og Cit)td c.1EZx� _Zip 9s�S <br />Phone No.( C?,7J 3 <br />C. Describe method to be sed for decontamination: <br />f�'tr� s� <br />d. Describe how rinsate mat wil a stored onsite prior to manifesting rfsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name�l/d "(C4� VPJ (4!5_ K1 9d/7 I ler Registration # x q <br />Address F 7� �� City Fel Zip q,5.-7/ sr' <br />Phone No. <br />Permitted Disposal <br />EH 23 046 (Revised 9/11/96) <br />R <br />(70i) <br />Page 40 <br />