Laserfiche WebLink
1. (a) Is there a EHD contraoV and subcontractor's questionnaire on file or used? YES W NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on file? YES W NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [] NO [ ] <br />(d) Has everyone on site, including crane/backhoe operator, been certified to work on <br />hazardous waste site in accordance with CCR Title S? YES Pq NO [ j <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES [b9 NO [ ] <br />3. Has ap licant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A YES 1' NO [ ] If YES, Permit # g it Co . <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAC4 YES[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO M <br />6. If tank residual exists, identify transporting hazardous waste hauler: 't CHD 028 Z��! �C9tS�rtlif IPe <br />Name, q _.&virOrnwFatl Sery;r-eS Hauler Registration# -0016 <br />A <br />��f�C? <br />Address�e�C f1—VC CityQr. +c Zip --- <br />a <br />Phone # <br />3i•I5so <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? <br />Address <br />Phone No.( 20 � ) E'S2�' C �1)Z- <br />c. Describe method to be used for <br />1E <br />YES >( NO [ ] <br />City IG �C zip <br />d. escribe how rinsate Lmaterial will be stored onsite prior to manifesting offsite: <br />ttlS(I}C U`1]] t1P VLtL�LUt t D( (Ui, i5\Ul ldCr it) 11l q <br />-otter � of 1 c 1r ;?>u± ( De;4f.-Mof� erdoon'in Nrnpitin 'I CF]TOi10 �335Z <br />e. Rinsate Hauler and permitted 'Treatment, Storage & Disposal Facility: Q�pituago5sa <br />Hauler Name]sU.Q I fnvii`M_MMrit0 SeTVl_CtS Hauler Reg-ilstration # Q� _ <br />Address'"!''�'TIE:�d�`Tye• city .N_ogGtt'�. Zip <br />CO 80 <br />Phone No. <br />Z3] -)5S-0 <br />,� �r f--%��t Z <br />Permitted DisposalSite(1w <br />eellYp n Nr) m W'O�TCgC'013'35Z <br />a. Describe the method that will be utilized to purge and/or inert, gthe tank(s): j j tl <br />r `'� C N +� SCN ?4? -T iCI:V t'i'Gii:.2) 01 <br />C,.]eG0. R l.r.YL ,. 1� � �_ i <br />b. Tank/PipingHauler: <br />Name <br />EH 23 046 (Revised 1 <br />Lp4; <br />El <br />Inc. <br />