Laserfiche WebLink
1. (a) Is the current certificate of worker's compensation insurance on file? YES,(c� NO [ ] <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? Y 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? YES, 1 NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job she been submitted? YE$,( NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit'? <br />N/A.{,�- YES [I NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NkYES[ ] NO[ ] <br />5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES[] Nwl� <br />6. If tank residual exists, identify transporting z/a/r�d.ous waste hauler. <br />Name 4ae <br />// N C[L Gr/ Hauler Registration # � <br />Address �'� 4.->(J �-7 3� City / LIY/_ Zip 9 r 315- <br />Phone#(�1y. 3� ��L C) <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YESJ< NO[] <br />b. Identify contractor performing decontamination: '' <br />Name . )I2a /NO�Z /11- o/Z GG <br />Address /V� ��X 7 / City Zip -..L <br />Phone No.(aL 9 <br />C. <br />will be stored onsite <br />e. Rinsate Hauler and Permitted Trea en Storage & Disposal Facility: <br />Hauler Name C/L C/ �'- Hauler Registration # _� <br />Address - DO X 3 !!?4j-2 city L` Zip <br />Phone No. ( 1 3 7 ,,.J U -7 //7 <br />Permitted Disposal Site <br />8. a. Desc2VIe m7thod that II be <br />b. Tank/Piping Hauler <br />inert the <br />Name U112-7 ((� el'o� <br />Address -1-90 c) >c :i 5-,7 city--(./ / zip <br />Phone No.( Lo T) -73 2-g <br />Hauler Registration # (if hauled as <br />EH 23 046 (Revised 8/1/11) <br />L/4 <br />h"4al, £/( l* -/7/S Cir) <br />/ CC 2-1,F <br />4 <br />