REMOVAL_1995 - Laserfiche WebLink

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I. (a) Is there a PIIS -13111) contractor's questionnaire on file or enclosed? YES IXI NO J I (b) Is the current certificate of worker's compensation insurance on rile? YES J7q NO 1 (c) Does the contractor possess a "llazardous Substance Removal Certilicaliun?" YES I1q NO I I 2. this a "Site Ileallb & Safely Plan" for this Job site been submilled7 YES I7q NO I 1 3. this applicant performing removal in the City of Tracy obtained a "Grading and Excavation Pernik"? N/A IX I YES i I NO I I If YES, Permit p 4. flag contractor obtained approval from the local fire department to perform tank cutting? NA JXJ YES ( J NO I I S. Is there knowledge or evidetn a of leakage from the lank(s) and/or piping? (If yes, please explain) YES I I NO 6. If tank residual exists, identify transporling hazardous waste hauler: Name: Nor -Cal Waste Oil haulers Ilauler Registration q: CAD 982417155 Address: P.O. Box 645 City: Denalr, CA Zip: 95316 Phone: (209)332-8710 7. Decontamination Procedures: a. Will tankOs) and piping be decontaminaled prior to removal? YES JXJ NO I I b. Identify contractor performing decontamination: Name: Jim Thorpe 011 Co., Inc. Address: 351 N. Beckman Road / P.O. Box 357 City: Lodi, CA Zip: 95241-0357 Phone No. 1209)462-4581 or(109)368-6175 C. Describe melbod to be used for decontamination: Tanks and piping will be triple rinsed wilh hot wafer and bimlegradable soap solution. d. Describe how rinsale material will be slored on-sile prior to manifesting off-site: 71ne rinsale will be removed by.1111i Thorpe 011, Inc., personnel and be placed In drums. The drums will be landed and stored not site awaiting pick up for disposal al a proper disposal C. Rinsate Ilauler and petmilled'1'reaonenl, Storage & Disposal Facility: Ilauler Name: Same as No. 6 Ilauler Registration N: Address: Phone No. City: Permitted Disposal Site: Refineries Services, Pal lerson, CA, or other approved facility. Page 4 Zip: