Laserfiche WebLink
12/10/2002 09:39 2094683433 FIFTH FLOOR PAGE 03 <br /> �. (a) Is there a Pt3S•BHA cont mctde:j and subcontrastoes questionflal a on flit)or enciased7 YES M NO[) <br /> (b) Is the current certificate of worker's compensation insurance on MeY VESA NO[] <br /> (c) Does the contractor possess a'Hazardous Substance Removal Certi.ticatfon'? FSS + No[] <br /> (d) Has,everyone an site.lncludl.4g cranelbacichae aperator,been certified <br /> to work as bazagdans waste site in accordance with CCR Title S? YESK No[] <br /> Has a"S1te Healdu tr Safety Plan*for this)ob site been submlttedY YESK NO[] <br /> 3_ Has applicant performing removal in the City of Tracy obtained a"Gr Adlog znd K=vatfaII Pearnir"? <br /> ?AAP, YES[1 N0[i if YES,"Permit 0 <br /> 4, Has the contractor obtained approval from the local fire department to perform tank crtVU91 NA14 TXS[I N01] <br /> 5. Is there knowledge or evidence of leakage from she tanKr%)andlur pipluff? Of yes,please tVIAN)US[] Mil I <br /> 8. If tank residual exists,identify traaspatting hazardous waste bat&r. ' <br /> 1 t C C•AD4&3 6.522?Z <br /> 0 <br /> Name ,010 G+CS a.` <br /> C rti V l R.D fti f�tG C�T'c3� Estller ArogisLrelifon! p <br /> Address 9104 1e+1[)V5T(%eJ Ww'i — —_atr iG zip gc{510 <br /> 1 Plyane.4( '70? '1q`7 66gq— - — <br /> 7, pecantamini<tlon Fracedurm: <br /> a_ Will ua*s)and plping be deeatttaminate d prior to removal? YES W. No[] <br /> b- Identify euntraewr perfarming deeomamloadoa: <br /> Address 1 l.uc3�s TNc�,k <.JL.�, --cityt G I�. _ZIP, <br /> Phone 104 "N'l 6613 <br /> C. Describe mediad to be used for 4eaoutamharlon <br /> d_ describe haw rtusate material WjU be stored anile phial ra manifesting offslte: <br /> JN LL SAM< &ti.. <br /> e. Rinsate Hauler and peranitted Treatment,Storage&Ulspasal FatdHW.. <br /> Hauler Name n 1 VbrSCL1 frv�(x d► Haar f3agtstraGan! �7 Z <br /> Address [ MCS U S f P � W� City [G __ Zip 4't1 S)0 <br /> Phone Iia, 10(_ 7ql <br /> PermittcdDispasalSit,--6r l iAVLROVti✓rl <br /> 6S�446 (Rarrised 11Ali3159) Pigs 4 <br /> 12/10/02 TUE 09:43 [TX/RX NO 87091 IJ003 <br />