Laserfiche WebLink
03-05-'07 17:09 FROM- T-046 P002/002 F-089 <br /> 1. (a) Is there a EHD contractN And subcontractor's questionnaire on file o*,Oiclosed? YES[J NO <br /> (b) Is the current certificate of worker's compensation insurance on file? YES Not] <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 8? YFS [ • NO(J <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YF,S( NO[] <br /> 3_ Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A() YES [] NO W If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA()YES[] NO[J <br /> 5. Is there knowledge o evidence of leakage from the tank's) and/or piping?JIf yes,please exp m)YES NO[) <br /> jJ L^'7�T r e c >ri/h P /Ll/ _ ii L ls%ft�r7 ee7,; l <br /> 6. If tank residual exists,identify transporting hazardous waste hagler: <br /> Name Ze t -ti74 n f'Lr/�� � �� ('(Hauler Registration# <br /> Address o/ Q- A& 11 5 JL City Zip 1 77 <br /> Phone# ( %3rC ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES[� NO(] <br /> b. Identify contractor performing decontamination: ' <br /> Name <br /> Address City zip 9YI-7 4o <br /> Phone No.( 531) <br /> C. Describe meth d to be used for decontamination: <br /> d. Describe how rins41Aate material will be stored prior to manifesting offsite: <br /> onsite <br /> '71 <br /> e. Rinsate Hauler and permitted T <br /> r <br /> eatment,Storage&Disposal Facility: <br /> Hauler Name C y C-1 0,'1 Hauler Registration#�o <br /> Address I m 9 L �rAfa r Y1 ex s� city La nCv- 'd Zip 9 S77 <br /> Phone No. ( 5[. C) ) to�-l-b''yCM0 I <br /> Permitted Disposal S1 1 t i::?k <br /> J, s, - s� <br /> or L) Iryr M <br /> EH 23 046 (Revised 11/21/06) {�/ 4 <br /> 0-. Lo 1, k hat(I -Fm �I-�1 of l <br />