Laserfiche WebLink
1. <br />2. <br />4. <br />7 <br />NO <br />(a) <br />Is there a EHD contractor's and subcontractor's questionnaire ani � or enclosed? Y�E�NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on ,{y <br />(c) Does the contractor possess a "Hazardous abo ante Removal <br />certified to Certification'"? <br />work a'"? , ( NO[] <br />(d) Has everyone on site, including crane/backhoeP YES N0 [] <br />(e) hazardous waste site in accordance with CCR Title 8? <br />YES NO[] <br />Has a "Site Health & Safety Plan" for this job site been submitted? <br />Has applicant performing removal in the City of Tracy obtained a "'Grading and Excavation Permit"? <br />YES [ ] NO [ ] If YES, Permit #— �/�,// <br />d approval from the local fixe department to perform tank cutting? NA�,YES[ ] <br />Has the contractor obtaine pP �' `\� <br />NO[ ] <br />Is there knowledge <br />NO [] <br />or evidence of leafage from the tank($) andlor piping? (If yes, please explain) YES <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Iltl Hauler Registration <br />Name S j <br />`G� City <br />Address l�� PG Zip <br />Phone # C L, <br />Decontamination Procedures: <br />a. Will tanks) and piping be decontaminated prior to removal? <br />b. Identify contractor performing decontamination: <br />YESX NO [ ] <br />Name J� tQfL /i 'G <br />/ City L 4 Zip c7fL� <br />Address C-- <br />Phone No.L-K::L� <br />C. Describe method to be used for <br />rinsate materia <br />Cl. Describe how l will be stored onsite prior tomanifesting offsite: <br />e" Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />��/ F Hauler Registration # <br />Hauler Name <br />p City I Zip / J <br />Address <br />Phone No. <br />Permitted Disposal Site—U, <br />EH 23 046 (Revised 3115/02) Page 4 <br />Zo <br />