Laserfiche WebLink
1. (a) Is there a PHS-EHD contractors questionnaire on Isle or enclosed? <br />ITS K <br />NO[] <br />(b) Is the current certificate or workers compensation insurance on Isle? <br />YES P( <br />NO [ ] <br />(c) Does the contractor possess a 'Hazardous Sabataom Rsoral Ccrt►6atlonR <br />YES <br />NO ( ] <br />2. Has a 'Site Health h Safety Plan' for this job site been submitted? <br />YES <br />NO (] <br />3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Excavation <br />Permit'? <br />N/A'K YES [ ] NO [ ] If YES, Permit # 1✓AIfJEt7 <br />4. Has the contractor obtained approval from the local fire department to perform tank <br />cutting? NA �j <br />``YES <br />YES(] NO[ <br />5. Is there knowledge or evidence or leakage from the tank(s) and/or pipin$? (If yes, please explai�n%// <br />J1Q NO [ <br />ne <br />Sinull s in Gt/'Q�nd wOSfe O%/ rA.tJk IC7 � 4, <br />O /hCG <br />fib o"ddc S1c.A of Gt Pa lec,j,-r- <br />6. If tank residual exists, Identify transporting hazardous waste hauler. <br />Name / ,j�rpoj=GV/ i R�SyVCtIA/b CD�00/Uf/Oil H�aym.erRegistration #ESA G4A083/�7 <br />Address/3731 N. NWS/ City/Dory?Snn Zip S 3 <br />Phone # ( 90() 1 'ES 7"1 414 <br />a. Will tank(s) and piping be decontaminated prior to removal? YESII4 NO [ ] <br />b. Identify contractor performing decontamination: <br />Name NA -r&14% FN11teQ J?4eA#AL S512L-1� LitJG <br />Address &6/ (Z City zip pis 3 76 <br />Phone No.( 7 D'7 ) 'V 23 —,07<9 <br />C. Describe method to be used for decontamination: <br />TAAJX tit)Tc,ele AJ& -71/ LV4 r,044C egNu VlfCuur <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name <br />Phone No. <br />Permitted Disposal Site <br />Puge 4 <br />City <br />Hauler Registration # <br />Zip <br />r. <br />