REMOVAL REMOVAL 1998 - Laserfiche WebLink

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1, (a) Is there a PHS-EIID contractor's questionnaire on file or enclosed? YES NO I I (b) Is the current certificate of worker's compensation insurance on file? YES NO I (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES a() NO ( j (d) fins everyone on site, Including eranelbackhoe operator, been certified to work on hazardous waste site In accordance with CCR Title 8? YES NO I I 2, Has ■ ,Site Health & Safety Plan" for this job site been submitted? YES b( NO I I 3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permli"? N/AVV YES I I NO I I if YES, Permit upon approval 4, fins the contractor obtained approval from the local fire department to perform tank cutting? NAI I YES[ I NON 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES I I NO.N 6. If tank residual exists, Identify transporting hazardous waste hauler: Name Nor Cal Waste Oil Haulers Hauler Registration # CAD 982417255 Address P. 0• Dox 645 City Denair, CA Zip 95316 Phone N{ 800 ) 332-8710 7. Decontamination Procedure$: a. Will tank(s) and piping be decontaminated prior to removal? YES pQ NO b. Identify contractor performing decontamination: Name Jim Thorpe Oil, Inc. Address P. 0. Box 357 City Lodi Zip 98241-0357 Phone No.{ 209 368-6175 c. Describe method to be used for decontamination: Tank(s) and piping will be triple rinsed with a biodegradable soap solution and hot wator- d. 'Describe how rinsate material will be stored onsite prior to manifesting offsile: Rinsate will hither be removed frons the tank the waste oil hauler while the tank and lines are bein rinsed or stored in labled and sealed drums ons to until they can be removed to a proper disposal facility. e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: Hauler Name same as #6 Hauler htegistratlon it Address City Zip Phone No.( ) Permitted Disposal Site Americlean, Inc. 2570 ,almond Dr., Silver Springs NV 89429 5/20 Ell 23 046 (Revised 9111196) Page 4