Laserfiche WebLink
i <br /> I. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? YES K NO[] <br /> (b) Is the current certificate of worker's compensation insurance on ftle? YES K, NO I[ <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES K NO I I <br /> (d) Has everyone on site,including cranefbackhoe operator,been certified <br /> to work on hazardous waste site in accordance with CCB Title 8? YESK NO[I <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES NO[I <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N1A$j, YES[[ NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NV�YES[I NO[I <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES I I NOpl� <br /> , <br /> 8. If tank residual exists,identify transporting hazardous waste <br /> _ � „ b auler: <br /> Name <br /> _Hauler Registration <br /> Address }p� rQ�2IL ., City et&LG Zip G c7 <br /> Phone#� <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESjQ NO[I <br /> t b. Identify contractor performing decontamination: <br /> f _ V <br /> Name �1aJGl'.5�� �,rlvti22,r1MAV1tr-�_�_ <br /> Address l I7 city Zip <br /> Phone No.( <br /> C. Describe method to be used for decontamination: <br /> .0csSurzc <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> 101 �VQGVVy1') f'rVe'k 4olt SGLMr. -06,4 "Pka. I <br /> e. Rinsate Hauler and permitted Treatment,Storage&Disposal Facility. <br /> fl Hauler Name ,�� `���I(L��„ri tT�1 HaWerRegletmtfon0 3b�2�`��+ <br /> I <br /> Address D City &A 16 Z<pg1 C7 <br /> Phone No. ? ?4� <br /> Permitted Disposal Site <br /> EH 23 046 Pvlsed 08113199) Page 4 <br />