Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES NO [ ] <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [K] NO [ ] <br /> (c) Does the contractor possess a 71arardoos Substance Removal CertIIlotlonR YES [Q NO [ ] <br /> 2. Has a 'Site Hearth&Safety Plan'for this Job site been submitted? YES 64 NO [ 1 <br /> 3. Has applicant performing removal In the City of Tracy obtained a *Grading and Excavation Permit'? <br /> N/A [ ] YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YES[ ] NON <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br /> 6. If tank residual exists, identify transporting hazardous waste hauler. <br /> Name P.(L.C, �4)7'E(Lt�oN Hauler Registration # <br /> Address_ 1331 N. tAUJU /_ city ZIP-1g526?, <br /> Phone # ( 0 �_ g _ ��J4. <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES Pq NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name Y 1-N E01 C, —r .CO (yO 10 'a I <br /> Address (Sun`ia1Xt &ca City LAKE �e-)uo zip <br /> Zj <br /> Phone No.( 1 ) l [ 3np <br /> C. Describe method t�,be used for decoq�amination: <br /> `TG11O1E KENS£ Gild VUcUum Pum <br /> d. Describe how rinsate material will be stored onsite prir to manifesting offsite: <br /> A'\ re � u�c�wc � � cV' <br /> e. Rinsate Haulerandpermitted Treatment, Storage & Disposal Facility: <br /> Hauler Namen ,PflTI'E 0(U ((Hauler Registration # <br /> Address 13331 N. N l vv k� city Yqt u'<X_'N zip 9,51Z_ <br /> Phone No. (c7�0� <br /> Permitted Disposal Site <br /> Page 4 <br />