Laserfiche WebLink
1 <br /> 1. (a) Is there a MEND contractor's and subcontractor's questionnaire on file or enclosed? NO[] <br /> (b) Is the current certificate of worker's-compensatlon insurance on f1le? NO[] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? NO[] <br /> (d) Has everyone on site,Including crane/backhoe operator,been certified <br /> to work on hazardous waste site in accordance with CC&Title 8? YES }, NO[] <br />,y Has a"Site Health&Safety Plan"for this Job site been submitted? YES NO[] <br /> 3. <br /> Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> mk YES[] NO[] If YES, Permit f <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?#� 4 <br /> E ]Na. Is there knowledge or evidence of leakage from the tanks)and/or piping? (If yes,please explain))YES(J NO <br /> i If tank residual exists,identify transporting hazardous waste hauler. <br /> Name P, Ranier Registration B 5 <br /> Address —city�3,\ H�U�� zip A <br /> Phonefl <br /> ( \C�► — 1 �� <br />% Decontamination Procedures: <br /> L WN tank(s)and piping be decontaminated prior to removal? YESX NO[] <br /> b. Identify contractor performing decontamination: <br /> Name <br /> Address 2 5 �� \� - LU� City F H\"(lu ZIP d 0 <br /> Phone No <br /> C. Describe method to be used for decontamination: <br /> --7 7Z,V -�ZlI eL R\ NI SE <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> L b,�'F 1 F-T,\ 71�)A �\A c <br /> e. Rinsate Ranier and permitted Treatment.Storage&Disposal Facility: <br /> Hauler Name C 1 Hauler Registration# <br /> AP R�< \//\l1 t\1�Zip <br /> ddress g U 1 <br /> Phone No.( � () ► - 1 5 3 <br /> Permitted Disposal Site C. <br /> CH 23 046 (Revised 10/19198) Page 4 <br />