Laserfiche WebLink
09/13/2007 TIEU 14154 FAX 083433 SJC EHD 0008/012 <br /> 1. (a) I:;there a 13HD contractor's and subcontrator's questionnaire on file or enclosed? YFS-W NO[] <br /> (b) 1;the current certificate of worker's compensation insurance on file? YCS'p` NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YP,S),V NO J) <br /> (d) I las everyorte=site,including crane/backhoe operator,been certified to work on <br /> lazardous waste site in accordance with CCR Title 87 YES P� NO[J <br /> 2. Has,t"Site Health do Safety Plan"for this job site been submitted? YRS]f NO[] <br /> 3. Has:q)ficant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A [I YFS[] NO[] If YES, Permit It <br /> 4. llas;he contractor obtained approval from the local fire department to perform tank cutting?NAJ]YIIS[] NO[] <br /> 5. Is th+:re knowledge or evidence of leakage from the tank(s)and/or piping? (If yes,please explain)YES[I NOX <br /> 6. If tar k residual exists,identify transporting hazardous waste hauler: <br /> Narne„_, Hauler Registration#__, <br /> Address-_ ---- --- —City Zip <br /> Phone#( --)--� <br /> 7. Deccntaarination Procedures: <br /> it. Will tank(s)and piping be decontaminated prior to.retnoval? YES() NO[] <br /> b. Identify contractor performing decontamination: <br /> Ntame......_.._.._._..._.........._.._ <br /> Address City —.._—..__ _..__;Zip.__._—..__.__.._._. <br /> Phone No.( <br /> C. Describe method to be used for decontamination: lecolntal'ri;t'1at.m Wim �e+'mk <br /> CM _— 1 13�—.k+ Lts M © y C SUP4-- <br /> d. Describe hobo rinsate rrtaterlal will be stored onsite prior to manifesting offsite: <br /> C. Rinsate Hiuler and permitted Treatment,Storage dr Disposal Facility; <br /> Hattler Name__.._... ._ .__. .� .._.._... . ._ �.Hauler Registration#--- <br /> Address_ _._ City Trip , <br /> Phone No. <br /> Permitted Disposal <br /> LFI 23 046 (Revised i It21106) 4 <br />