Laserfiche WebLink
1. (a) Is there a PIIS-EIID contractor's questionnaire on rile or enclosed? YES [ ] NO <br /> (b) Is the current certificate of worker's compensation insurance on file? YES VINO [ ] <br /> (c) Does the contractor possess a 'Hazardous Substance Removal Certification"? YES % NO [ ; <br /> 2. IIas a 'Site Health & Safety Plan' for this job site been submitted? YES [/NO [ ] <br /> 3. Has ;; R <br /> Unt performing removal in the City of Tracy obtained a 'Grading and Excavation Permit'? <br /> N/A YES [ ] NO [ ] If YES, Permit # <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAPYES[ ] NO[ ] <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br /> 6. If tank residual exists, identify tra porting hazardous waste hauler. <br /> Name Hauler Registration # <br /> Address i _`' City Zip <br /> Phone # ( ) <br /> 7. Decontamination Procedures: <br /> a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO [ ] <br /> b. Identify contractor performing decontamination: <br /> Name ��iaGx'f�N `l' v►e.�- "J �Q, Go <br /> Address (!Iii Ot�l R71 city Zip 40-Z-01r, <br /> Phone No. �� h C. Des ibe method to be used for decontamination: <br /> 1! t t�l"r7Ar��i <br /> d. Des w rinsate material will b ored onsite prior to manifesting o ite: <br /> e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> Hauler Name Hauler Registration# <br /> Address :. City Zip <br /> Phone No. ( ) <br /> Permitted Disposal Site <br /> Page 4 <br />