Laserfiche WebLink
1. (a) Is there a PHS-EHD contractors questionnaire on file or enclosed? YES)( 1 NO I 1 <br /> (b) Is the current certificate of workers compensation insurance on file? YES [X1 NO [ 1 <br /> (c) Does the contractor possess a 'Hazardous Subeb ce Removal Certification? YFS () NO [ 1 <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES [XI NO 11 <br /> 3. Has applicant performing removal In the City of Tracy obtained a 'Grading and Mxwwatlon Permie? <br /> N/A [ 1 YFS [ 1 NO [ 1 If YFS, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAf 1 YES[ 1 NO[ 1 <br /> S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ 1 NO [ 1 <br /> 6. If tank residual exists, Identify transporting hazArdous waste hauler- <br /> Name <br /> aulerName Haver Registration # <br /> Address City Zip <br /> Phone # ( ) <br /> 7. Dasvhmimtion Procedures: <br /> 9. 8911 tank(s) and piping be decontaminated prior to removal? YES [XI NO [ ) <br /> b. Identify contractor performing decontamination <br /> Name Pavdirt Excavating Co Tnr - <br /> Address 269 OReeon City Ri car_ Zip <br /> Phone No.( 209 ) 599-2347 <br /> C. Describe method to be used for decontamination: <br /> Tanks will be triple rinsed <br /> d. Describe how rinsate material will be stored onsite prior to manifesting of lte. <br /> Rinsate will be out in barrel c and d' cn I f h- <br /> e. <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility <br /> Hauler Name Refeinery Services (PRM Hauler Registration # p� <br /> Address City Zip <br /> Phone No. ( 1 <br /> Permitted Disposal Site <br /> Page 4 <br />