Laserfiche WebLink
1. (a) Is there a PHSEHD contractor's and subcontractor's questionnaire on file or enclosed? YES J�✓ NO I J <br />YES(b) is the current certificate of worker's compensation Insurance on file?za]N iN(] <br />(c) Does the contractor possess a 'Hazardous Substance Removal certification'? ] NO[] <br />(d) Has everyone on site. Including cranelbackhoe operator, been certified <br />to work on hazardous waste site In accordance with OCR Tltie 87 YES J� NO 1 ] <br />Z. Has a "Site Health & Safety Plan' for this Job site been submitted? YES ] ] NO.} f/ <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA 14 YES ] ] NO J J - If YES, Permit f <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAj4Y J NO( ] <br />5. Is there knowledge or evident, of leakage frR m the tanb�s) andlor Ipingl (lf yes, please explain) YES j J NO ( ] <br />l iidl2i N9S��S�rt1� <br />G. if tank residual ensu, Identify transp�o`rting hazardous waste hauler. �.MD y <br />Name M� ` IyO� d f L Hauler Registration dq /�? �/r7 2�S <br />Address �li i3dX 5 city (2Vlnfl ZIP q_53l% <br />Phoned 1 r (077 669Z <br />7. Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to removal? YES ] ] NO[] <br />b. Identify contractor performing decontamination: <br />Name 6 <br />Address A/ PJ I SOCity UP 'IZJ ZOJ <br />Phone No 14J% <br />c. Describe method to be used for <br />d. Describe how rinsate material will be stored ogsite prior to manlfesttny otfslte: <br />e. Rinsate Hauler andpermittedTreatment, Storage & Disposal Facility: r/ <br />Hauler Name Na( �l� // (� H 2_ rauler Registradon l �.2 <br />Address rpD ��C 1��� Olty T)?,l f/ ZIP b <br />Phone No.( <br />Permitted Disposal Site /1 �LU t6c) <br />EH 23 046 (Revised I 01391 Page 4 OD D <br />