Laserfiche WebLink
M <br />1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES [zj NO ( ] <br />(b) Is the current cerdlicate of worker's compensation insurance an lila? YES NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certiflcadou"? YES NO [ j <br />(d) Has everyone an site, including crane/backhoe operator, been certified <br />to work on hazardous waste site In accordance with CCR Title 87 YES 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 />MAY, YES [ ] NO[] If YES, Permit .# <br />4• Has the contractor obtained approval from the local fire department to perform tank cutting? NAUYES[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] N0 <br />S. I1 tank residual exists, identify transporting hazardous waste hauler. <br />Name NorCal Waste Oil Haulers Hauler Registration# CAD 982417255 <br />Address P.O. Box 643 City Denair, CA Z(p 95316 <br />Phone #( 800 1 332-8710 <br />7. Decontamination Procedures: <br />a. will tank(s) and piping be decontaminated prior to removal? YES [T NO[ 1 <br />b. Identify contractor performing decontamination: <br />Name Jim Thorpe Oil, Inc. <br />Address P.O. Box 357 <br />Phone Nol 209 1 368-6175 <br />Cty Lodi, C9 Zip 95240 <br />c. Describe method to be used for decontamination: <br />Tank(s) and piping will be triple rinsed with a biodea-r eable <br />soap so ution and hot wter. <br />d. Describe haw rinsate material will be stored onsite prior to manifesting offsite: <br />The rinsate will be removed from the tanks a <br />� it is bping <br />delivered to the opposite end of the tank <br />e. Rlnsate Hauler and permitted Treatment. Storage & Disposal Facility: <br />Hauler Name Same as '6 Hauler Registration.# <br />City <br />Phone No. <br />Zip <br />Permitted Disposal Site Americlean Inc 9570 A,____, <br />S.a.I c Q r lugs, Nv. <br />or other approved facility. <br />EH 23 046 (Revised 10119198) Page 4 <br />