Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES K] NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on rile? YES I() NO I ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certirimtion"? YES KI NO [ ] <br /> 2. Has a 'Site Health & Safety Plan' for this job site been submitted? YES K] NO [ I <br /> 3. Has applicant performing removal in the City or Tracy obtained a 'Grading and Excavation Permit"? <br /> N/A K] YES I ] NO I ] Ir YES, Permit # <br /> 4. Has the contractor obtained approval from the local lire department to perform tank cutting? NAQQ YE,S[[ NO[ ] <br /> 5. Is there knowledge or vidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES DCI NO [$ <br /> �J- -9�4 /a Z p �l t)Kj <l � d not Set his ///\\\ <br /> 6. I�residual exists, Identiry transporting hazardous waste hauler: <br /> Name?� � f ` p / �`��U ler Registration # <br /> Address City Zip <br /> Phone # ( ) <br /> 7. Decontamination Procedures: <br /> a. Willpiping be decontaminated prior to removal? YES [ ] NO [I±) <br /> h. Identify contractor performing decontamination: <br /> Name <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Stornge & Disposal Facility: <br /> Hauler Name Hauler Registration # <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />