Laserfiche WebLink
............I �) <br /> there a contractor's quevwaire on file? NA[j YES aj NO [J <br /> a) 1s Ube questionnaire enclosed? YES [j NO [I <br /> b) Is the current OCUACUO of wodwes Compensation insurance on file? YES NO [J <br /> c) Does contractor possess a •Hazardous Substance Removal Actions Cert.•? NA[j YES NO [j <br /> 2 Has a•Slte ROMb do SahtY Plea•for this job site been submitted? YES pQ NO [j <br /> 3. Has applicant performing removal in the City of Tracy obtained a•Gradiag andly�ocaystioa Permit•? <br /> r <br /> N/A[+!' YES [] NO[j It YES.Permit#► <br /> 4` kbvc mss) Pi a I PC leaked in the past? YES [j NO [i.} <br /> S. What will be the disposition of the tank(s)/piping? <br /> D1S 1pfel& <br /> c 4 A LOICLGV <br /> L-AdMi"10da - FleAfMAN -0 (W <br /> 6.. Has the contractor obtained approval from the lowl fire department to perform tank cutting?NA[j YES[J NO[ j <br /> 7. Decontamination Procedures: <br /> a. Identify contractor Pertorntiag decontamination <br /> NameAddress IM Zt <br /> T City oo STn p 1 <br /> Pbone`Nod Z2 — <br /> b. :Will tanks)and piping be,:decontaminated? YES NO [J <br /> C. Ime used.to clesn,tank(s) "A r pi g,Of mot in connacmes foe): � <br /> t <br /> i aON %AS,*"U aV A D rl ,w <br /> 1w ' 0 W WjMSqES <br /> d. Describe how rinsate material will be stored on site prior to manifesting afisite; <br /> Nt <br /> 6►S <br /> 6. State Registered Hazardous Waste Haul=and Permitted Disposal Facilities. <br /> a. Residuai/Hazfrdous W Hauler <br /> Name ' O OK. <br /> Address lam <br /> City O State GA ._ Zip <br /> Phone No. <br /> Hauler Registration #ti tail <br /> Page 4 <br />