COMPLIANCE INFO_1991-2000 - Laserfiche WebLink

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. 1. (a) Is there a PHS-EHD contractor's and subcontractor's questionnaire on file or enclosed? (b) Is the current certificate of worker's compensation insurance on file? (c) Does the contractor possess a "Hazardous Substance Removal Certification"? (d) Has everyone on site, including cranelbackhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? 2. 3. 4. 5. Has a "Site Health & Safety Plan" for this job site been submitted? Has applicant performing removal in the City of Tracy obta ed a "Grading and Excavation Permit"? NIA [ ] YES ( ] NO [ ] If YES, Permit # YES [, NO [ j YES 14 NO YES fj NO [ ] YES[;] NO[] YES kj NO [ ] Has the contractor obtained approval from the local fire department to perform tank cutting? NAr'j YES[ ] NO[ ] Is there knowledge or evidence of leakage from the tank(s) andlor piping? (If yes, please explain) YES [ ] NO C 6. If tank residual exists, identify transporting hazardous waste hauler: Name 6 6 /V i-,11, o N!%V4 fiauler Registration # 002 V,2 - Address _S' i11 / %fr j L! City 'AIZ-410 41-1-2 Zip&I Phone # ( 'i�`f iL, ) cj 2 2 — --57 --2 = !/ 7. Decontamination Procedures: • a. Will tank(s) and piping be decontaminated prior to removal? YES M NO ( ] b. Identify contractor performing decontamination: Name 0 fl Zr'S/ C o s r6 _ Address �— C t,/ AIT -14 G 77 p City -- /l &--A;-1,4 tit 6 N r�lp S 6 Phone No.( 4 ' / 6 ) l rr / -� /_ f2 1 C. Describe method to be used for decontamination: d. Describe how rinsate material will be stored onsite prior to manifesting offsite: i 0AC 0 —, e e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: 1_ Hauler Name �!%� �` /�E-= lt/ �✓l V i�C NV IO� Hauler Registration# Address * C City F Com" A<,e' Zip C� 6 Phone No. ( 92 ;2- -S .2 - Permitted Permitted Disposal Site (,16—& 6 C -Z EH 23 046 (Revised 08113199) Page 4