Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES[] NO[J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES(] NO[J <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES(] NO(] <br /> (d) Has everyone on site,Including crauelbackhoe 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 NO[) <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA[] YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[J YES[]NO[] <br /> 5. is there knowledge or evidence of leakage from the tanks)and/or piping? (If yes,please explain)YES[J NO <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Name Evergreen Environmental Hauler Registration# 0242 <br /> Address 6880 Smith Avenue Clty Newark 21p_14560 <br /> Phone#( 800 ] 972-5284 <br /> 7. Decontamination Procedures: <br /> a. Will tasks)and piping be decontaminated prior to removal? YES[J NO[] Tanks—Yes <br /> Piping-No <br /> b. Identify contractor performing decontamination: <br /> Name Town & Country Contractors, Inc. <br /> Address3373 Luyuncf Drive (3tYRancho ZIP 95742 <br /> Cordova <br /> PhoneNo4 916 ) 636-9500 <br /> C. Describe method to be used for decontamination: <br /> Steam cleaning <br /> d. Describe haw rinsate material will be stored onsite prior to manifesting offsite: <br /> In 55 gallon drums <br /> e. Rtmate Hader and permitted Treatment,Storage&Disposal Facility: <br /> Hader Name Evergreen Environmental Hauler Registration# 0242 <br /> Address 6880 Smith Avenue City Newark Zip 94560 <br /> Phone No.( 800 1 972-5284 <br /> Permitted Dismal Site Same as above. <br /> 1123 040 (Revised 10119198) Page 4 <br />