Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES(tj NO[J <br /> (b) Is the current certificate of worker's compensation insurance on file? YES[1 NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YESio NO[J <br /> (d) Has everyone on site,Including cranetbachhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? 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 /> NIAX YES[] NO I J If YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?No]YES[]NO[J <br /> S. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (lf yes,please explain)YES[J NO b <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name w Hauler Registration N <br /> Address City Zip <br /> Phone N( 1 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[4 NO[J <br /> b. Identify contractor performing decontamination: <br /> Name JAI,!ES J. H03LITZELL <br /> Address 30" 330331 city STOCKTON,C,A Zip 95213-0331 <br /> Phone No{ 209 ) 943 7793 <br /> c. Describe method to be used for decontamination <br /> USING HOT HIGH PRESSUPE MATER AND F CO°1"1ERCIAL NON HA' OGS?IATFn ri FArdFR <br /> TRIPLE PI14SE TANKS AND EVACUATE P.INSEATE FOR IP`,"1EDTATF TR40,11pnRT ANr <br /> PROPER DISPOSAL <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offalte: <br /> IT U'11-1- NOT 3E STORED IT WILL 3E I°u'^EDIATFI Y TDANSPORTP'l nFF cL - <br /> A VACULtP TRUCK FOR PROPER DISPOSA 'IriDGR "1ANIFFST <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name riOR CAL OIL Hauler Registration# 2412 <br /> Address 3OX 645 City DE1I.AIR,C,A zip 95:16 <br /> Phone No.( R n n 1 -M 271 ,) <br /> Permitted Disposal Site AVIERICLEAN 2570 AL^IOND DRIVE SILVER SP^INGS,NEVAD.A 89429 <br /> EH 23 046 (Revised 10119198) Page 4 <br />