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REMOVAL_1995
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231667
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REMOVAL_1995
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Entry Properties
Last modified
6/18/2019 4:22:51 PM
Creation date
11/7/2018 5:07:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
1995
RECORD_ID
PR0231667
PE
2361
FACILITY_ID
FA0002121
FACILITY_NAME
JAMAR SERVICE
STREET_NUMBER
4075
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
95215
APN
15726411
CURRENT_STATUS
01
SITE_LOCATION
4075 E MAIN ST
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\4075\PR0231667\1995 REMOVAL .PDF
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EHD - Public
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• I. (a) Is there a PIIS-EIID contractor's questionnaire on file or enclosed? YES [ ] NO <br /> (b) Is the current certificate of worker's compensation insurance on file? YES [r]/O [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification'? YES We NO [ ] <br /> 2. Ilas a 'Site Health & Safety Plan' for this job site been submitted? YES V NO [ ] <br /> 3. IIas appjjanrifilt performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A YES [ ] NO [ ] If YES, Permit # <br /> 4. IIas the contractor obtained approval from the local fire department to perform tank cutting? NA[Y1"6 [ ] NO[ ]/ <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO lvl <br /> 6. If tank residualsxiissts, O !!ffa identify transporting hazardous waste hauler. <br /> NameG1=[ {�'I cS �Ci�'$ Hauler Registration #� <br /> Address /5'.33% AID., /w�l city��— zip <br /> —� <br /> Phone # ( ) gG 7 r7 77�/ <br /> • 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [,r- NO [ ] <br /> b. Identify contractor performing decontamination: / T <br /> Name STZC V— tl �t L�Yt Lt=_ -�'tictsl C r, pC.� <br /> Address O� t10. Jff'Lll� Vii, City—S. TL`l� Zip (t:-0Q <br /> Phone No.( 33 <br /> C. Describe method to be used for decontamination: <br /> FA nL gAoir— <br /> d. Describe howy�rinsate material will be stored onsite prior to manifesting ot site. <br /> I/CJT IIuaS At.[D � V1EPJ2C C— R l=/f.1ERl <br /> ( rtL 2u Y14� / S <br /> e. Rinsate IIaulerand permitted_Treatment, Storage & Disposal Facility: <br /> IIauler Name� Hauler Registration # <br /> Address 13 S,S'/ k/o r �� city LRMLLMSOAL zip_q 36,3 <br /> . Phone No. <br /> Permitted Disposal Site <br /> Page 4 <br />
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