Laserfiche WebLink
1. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire an file or enclosed? YES[aJ NO[) <br /> (b) Is the current certificate of worker's compensation Insurance on file? YES Noll <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO[) <br /> (d) Has everyone on site,including cranefbackhoe operator,been certified <br /> to work on hazardous waste site In accordance with CCR Title 8? YES NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES NO[j <br /> Sz e4,1 f (a.-. )S n— - �,(,— V 0\,, PH5-ci+D - <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and E=vation Permit"? <br /> NIA YES[] NO[j IP YES, Permit# Gt } C-C- <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA[l YESD'(NO[j <br /> 5. Is there knowledge or evidence of leakage from the tank(s)andlor piping? (If yes,please explain)YES)j NO]] <br /> PA'TV �5 Scr (J rPSJI+ S <br /> 6. If tank residual exists,identify transporting hazardous waste hauler. , <br /> Name M P E 01,r n ( -�- I i TA-x- Bauler Registration/ Z 61'S <br /> Address �31-(oD Me- +- City G zip <br /> Phone#( (� (o 1 ) 3 S' <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES A Noll <br /> b. Identify contractor performing decontamination: <br /> f <br /> I Name P' lam,j��c .ti �-T/ <br /> Address --,7-, City. /c-vZi <br /> p <br /> Phone No.( <br /> C. Describe method to be used for decontamination: <br /> ( L r\,0,)C <br /> d. Describe how rinsate material will be stored onsite prior to ma/nifes/ting offslte' <br /> Aj <br /> e. RLusate Hauler and permitted Treatment,Storage&Disposal Facility: <br /> Hauler Name M �J }� ( �Hander Registration c <br /> Address 5-�, J 4'c, a v SF City �j c lca✓s � �� ZIp g <br /> Phone No, <br /> Permitted Disposal Site Lc,, - cAk)d2t;L4o5c I <br /> i <br /> EH 23 046 (Revised 08113/99) Page 4 <br />