Laserfiche WebLink
1. (a) Is there a PHS-E,HD contractor's questionnaire on file or enclosed? YES k(] NO [ I <br /> (b) Is the current certificate of worker's compensation insurance on file? YES) ] NO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'! YES M NO [ ] <br /> 2. Has a 'Site Health&Safety Plan'for this job site been submitted? YES)�k NO [ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a 'Grading and Emvation Permit'? <br /> N/A'W, YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ ] YESN NO[ ] <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 � I C K So"J Hauler Registration # O/ `/ _ <br /> Address o2 S r4, k Q City nvr Zip <br /> Phone # <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES �J NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name a_ <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for,decon�mination: <br /> d. Describe how ripsate ratenal will be stored onsite prior to manifesting onsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler NameHauler Registration # Q <br /> Address City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />