Laserfiche WebLink
] <br /> I, (a) Is there aPHS-EHD contractor's questionnaire on file or enclosed? YES E4 NO [ <br /> (b) Is the current certificate of worker's compensation insurance on file? YES W('--NO [ ] <br /> (c) Does the contractor possess a'Hmrdoas Substance Reowyal Cep 0102tioa'? YES NO [ ] <br /> 2. Has a 'Site Health&Safety Plea'for this job site been submitted? YES NO [ ] <br /> 3. Has pplicant ormi removal the Cl of Tracy o ed sad <br /> N! [ ] [ l NO ] If;f1re <br /> �, ermit#t <br /> 4. as the con ctor o fined a ravel thed en pe�to tank cutting' NA[ YES[ ) NO[] <br /> 5. Is there knowledge or evidence Qf leakage from the tank(s) and/or piping? (If yes, please explain) YES [] NO [] <br /> 6. If tank residual exists, Iden y transporting azardous waste haule <br /> Name Heater <br /> Address City Zip <br /> Phone # ( ) <br /> 7. Deomtamination Procedures: <br /> a. Will tisdr*.as 1Tlping be decontaminated prior to removal? YES NO [ ] <br /> b. Identify contractor performing <br /> +decontamination: <br /> Name�k kl ( 1 o.41.r-'5 t <br /> Address tl •O , �L�D� 1004 City nLaot� Zip Qts 37 <br /> Phone No.( <br /> C. Descr method to,be used for decontamination: <br /> d. Describe how Onsalp material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler-and permlttaLTTreatment,.Storage &.Disposal Facility: <br /> Hauler Name Healer Rg0sbration# a 5 9 9S <br /> o <br /> Address tty zip— __,� <br /> /-Poo 7G 7_ 7 y/ 3/ <br /> Phone No. (�_) ,l <br /> Permitted Disposal Site FP/`� G'f���f3 /4, 4 �f <br /> 0641�FOa /� o <br />