Laserfiche WebLink
1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES U�NO[] <br /> (b) Is the current certificate of worker's compensation insurance on tile? YE NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YE NO[] <br /> (d) Has everyone on site,Including crane/backhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCR Title 8? YES�j NO[] <br /> 2. Has a"Site Health&Safety Plan"for this Job site been submitted? YE�} NO[] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIA YES[] NO[] It YES, Permit M <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?Nle YES[]NO['] / <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain) \YES[] NO ry( <br /> 6. If tank residual exists,Identify transporting hazardous waste hauler. <br /> Namef117�/(�{ ?Hauler/R/egtstratlon N <br /> Address `Q DO,/ ,3 �0 City /�E��7 / Zip cz f3/ <br /> Phone# BO L3 31�2 0/0 <br /> 7. Decontamination Procedures: <br /> a. Will tanks)and piping be decontaminated prior to removal? YEarpd NO[] <br /> b. Identify contractor performing decontamination: !� <br /> Name U/??r✓I �i%p/C/J� O/Z/n/C. <br /> Addressy�7 d�C.>�i�.� City Zip 25 4/J <br /> Phone No.( 2o2 ) <br /> C. Describe a od to be used for decon on: <br /> iii,✓ <br /> & ell� <br /> d. Describe how rhtsate mate al will be!tore onsite prior to manlfe ting site�P�n�.�a 2dr/ i�✓C �� �7/7 <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> ��/ <br /> Hauler Name IC/fj 14&�Z 4tl,�4 s/Z Hauler RRegistration <br /> Address ��D -6Dx _416—) City P&6 Zip <br /> Phone No.( 9OD ) 3 g�710 <br /> Permiits dDIsposalSite /A/lJ Fly/reg J <br /> f LfLfL <br /> EH 23046 (Revised 10119198) 6. O./C /� <br />