Laserfiche WebLink
1. (a) Is there a PHS-IIID contractees questionnaire on file or enclosed? YES [l3 NO <br /> on -Me. <br /> (b) Is the current certificate of worker's compensation Insurance on nit? YES NO <br /> o [ 1 <br /> �� <br /> (c) Does the contractor posseae a 'IIasasdoasSobataore Ressoral Catl(lotlau? YESQ]/� NO [ ] <br /> I Has a'SYe Haft&Snhq Pkas'for this Job site been submitted? YES [vl NO [ ] <br /> I Has apylicaut performing removal In the City of Tracy obtained a *Grading and Rsovatim Permit? <br /> N/A V] YES [ ] NO [ ] if YES, Permit # / <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA" M[ ] NO`[ ]/ <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piphrg? (If yes, please explain) YES [ ] NO ['] <br /> 6. If lank residual exists, Identify transporting hazardous waste hauler /25)&6t-/ &4c�w-e ex/5't- <br /> Name HauIW Registration # <br /> Address City Zip <br /> Phone# ( ) <br /> 7. Demotmelsotlon Psocedusass <br /> R. Will tank(s) and piping be decontaminated prior to removal? YES ly NO [ 1 <br /> L Identify contractor performing decontaminations <br /> Name / (� EY ILlI.UQ (Y1U �0 SYI6__ <br /> AddressOV(f!7 J City I7 zip 3A <br /> a2 <br /> Phone No.( 69 ) _W7/ -j3gl <br /> G Describe method to be used for decontaminations <br /> d. Describe h rine te material will be stored onsite prior to manifesting o Itr. <br /> ,tT// /V/ k �54od Dwr k 4r / P112 ./j)/// <br /> ij)/// <br /> c fi& iii�� 191E, Ag <br /> 7 h r <br /> a Riusate Hauler and permitted Treatment, Storage & Disposal Facilltr. <br /> Hauler Name Alner/CQ/� 1�al�eu r�V//D%!ZP/� enter Registration <br /> Address 2 g�3�0 6�y�- /�1 city —Twllot� zip �35� <br /> Phone No. ( (X�U <br /> Permitted Disposal Site <br /> Page 4 <br />