Laserfiche WebLink
1. (a) Is there a PHS -E® contractor's and subcontractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation hotrance on foe? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(d) Has everyone on site, including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with CCB. Title 8? <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />Has a "Site Health & Safety Plea" for this job site been submitted? <br />Hasap ant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIAWYES (I NO [ ] If YES, Permit # <br />YES [3[ NO [ ] <br />YES N NO [ ] <br />YESN NO[] <br />YESjq NO [ [ <br />YESId No [I <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NA[IYES[ ] NO[ ) <br />Is there knowledge or evidence of leakage from the tanks) andlar piping? (If yes, please explain) YES [ ] NO [ ] <br />If tank residual exists, Identify transporting hazardous waste hauler. <br />Name American Valley Waste Oil HaulerganlerRsgls=tlon# CAL 000827878 <br />Address P.O. Box 340 City Delhi, CA yip 95315 <br />Phone #(800 ) 332-8710 <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YESU( NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Jim Thorpe Oil, Inc. <br />Address P.O. Box 357 <br />Phone No.( 209 ) 368-6175 <br />City Lodi, CA <br />yip 95241-0357 <br />C. Describe method to be used for decontamination: <br />Tank(s) will be triple rinsed with a biodep:radeable soap solution <br />and hot water. The associated lines will be done in a similar way. <br />d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br />Rinseate will either be removed from the tank and lines as they are <br />heing rincarl by +ha wnqtp hn7iltar-ed J -n lea -Ighl'.ad until <br />they can be pumped out. <br />e. Rinsate Hauler and permitted Treatment. Storage & Disposal Facility: <br />Hauler NameAmer ican Valley W.O. Haulers Hauler Registration CAL 000827878 <br />Address P.O. Box 340 City Delhi, CA yip 95315 <br />PhoueNo.( 800 1 332-8719 <br />Permitted Disposal Site Americlean Inc. 2570 Almond Dr., Silver Springs " NV <br />or other approved facility. <br />arr 91 aea rRnvlaeA aR113/991 Pate 4 <br />