Laserfiche WebLink
i. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire an file or enclosed? YESNO[] <br /> (b) Is the current certificate of worker's compensation Insurance an file? YES KJ NO[[ <br /> (c) Dees the contractor possess a"Hazardous Substance Removal Certification"? YES)Q NO(] <br /> (d) Has everyone an site,Including cranelbackhoe operator,been certlfied <br /> to work on hazardous waste site in accordance with CCR Title 87 YES NO([ <br /> 2. Hasa"Site Health&Safety Plan" for this job site been submitted? Attached YES kl NO[] <br /> 3. Has applicant performing removal In the City of Tracy obtained a"Grading and Excavation Permit"? <br /> NIAX YES[] NO[J If YES, Permit N <br /> 4. Has the contractor obtained approval from the local am department to perform tank cutting?NA(]YES[J N--f <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES(J MIX <br /> G. If tank residual exists,Identify transporting hazardous waste hauler. N/A <br /> Name Hauler Registration d <br /> Address City Zip <br /> Phone d( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YESTr� NO[I <br /> b. Identify contractor performing decontamination �� <br /> Name Pile Construction <br /> Address P.O. Box 293688 city Sacramento zip 95829 <br /> Phone No{ 916 ( 688-5954 <br /> c. Describe method to be used for decontamination <br /> Triple rinse with High pressure washer <br /> d. Describe how Ansate material will be stored onsite prior to manifesting offsite: <br /> In 1000 gallon convault. If sample results indicate rinseite is acceptable <br /> or sewer dischar e an sewer is ric approves, rinses e wille <br /> di ed to <br /> sewer unde acs i les sewer discharge permit. <br /> e. Rlnsate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name Evergreen Hauler Registration f 0242 <br /> Address 6880 Smith Avenue it, Newark Zip 94560 <br /> Phone No.( 510 ) 795-4400 <br /> Permitted Disposal Site Evergreen Oil (EPA# CAD 980 887 418) <br /> EH 23 046 (Revised 10119198) Page 4 <br />