Laserfiche WebLink
1. (a) Is the current certificate of worker's compensation insurance on file? YESA NO[] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YES X NO[] <br /> (c) Has everyone on site,including crane/backhoe operator, been certified to work on <br /> hazardous waste sites in accordance with CCR Title 8? YESA NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES N NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/AK YES[] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[]YESK NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes, please explain)YES[] NOA <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. <br /> Name W � 1a <br /> ams ��1'�y1u'S Hauler Registration# 'Ac U 3?fJ2 <br /> Address LAW • Z+ \1 b"ao H Vd, City v 'efv Zip %7-46 <br /> Phone#( �910 ) 62.3- yLAb0 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES)4 NO[I <br /> b. Identify contractor performing decontamination: <br /> NamehdamS layios <br /> Address t-t�Q E • Mo y\(�kl(j�AVI✓J1 City �I�r�`� Zip 6VL45 <br /> PhoneNo.( -J1u <br /> C. Descrige methoqq�to be used for decos�amination: <br /> "TS'1 71 n ,W Gtyvi rp t * t fi>� �A 1 I kS• <br /> d. De;�rib�_h rinsat�(gaterial will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name Ad Yrs, &,rY1CP5 Hauler Registration# CAT <br /> AddressLAIN D r=• P/C1 1;1MVC/iL-�1ZU City �7]/t Yj � Zip q U�-L4E5 <br /> PhoneNo. ( 710 )✓L3 -4w)c <br /> Permitted Disposal Site_DLJ3MV1noI O N 200 1"-1 - WCU'Yl¢da, CQ1M <br /> 8. a. Describe the method that will be utilized to purgge and/or inert the tank( <br /> ¢): <br /> U <br /> At1t ]bJ O /'A1, A 1(t 1P 110oU ��S' anA <br /> b. Tank/Piping Hauler: <br /> Name '�5{LVAIR, � �r <br /> Address Un CO lt—= • �NAPh AA� N ityGay-d zap 610146 <br /> Phone No.( ` )jlZj r-% 1EIVED <br /> n f <br /> Hauler Registration#(if hauled as hazardous) CAT Ubc)b <br /> SEP 18 2013 <br /> EH23046 (Revised 10/30112) 4 rt ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />