COMPLIANCE INFO_1991-2000 - Laserfiche WebLink

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1. (a) is there a PIIS -P-111) contractor's questionnaire on rile or enclosed? YES JXJ NO ( J (b) Is the current certificate of worker's compensation insurance on file? YES Ix1 NO I (c) Does lite contractor possess a "llazardous Substance Removal Certification?" YES IM NO I J 2. Ilan a "Site Ilealth & Safety Platt" for this job site been submitted? YES IXI NO ' J 3. Ilan applicant performing removal in the City of'rracy obtained a "Grading and Excavation Permit"? NIA IX I YF -S I I NO I I If YES, Permit # 4. Ilas contractor obtained approval from the local Cue department to perform tank cutting? NA JXJ YES I J NO I I 5. Is there knowledge or evidence of leakage from the lank(s) and/or piping? (If yes, please explain) YES I I NO V1 6. 7 If tank residual exists, identify transporting hazardous waste hauler: Name: Nor -Cal Waste Oil haulers Ilauler Registration #: CAD 982417255 Address: C.U. Box 645 City: Denair, CA Zip: 95316 Phone: (209) 332-8710 Decontamination Procedures: A. Will tankOs) and piping be decontaminated prior to removal? YES JXJ NO I I b. Identify contractor performing decontamination: Name: Jhrr Thorpe Oil Co., Inc. Address: 351 N. Beckman Road / C.U. Box 357 City: Lodi, CA Zip: 95241-0357 Phone No. (209) 462-4581 or (209) 368-6175 C. Describe method to be used for decontamination: Tanks and piping will be triple rinsed with hot wafer and biodegradable soap solution. d. Describe how rinsme material will be stored on -side prior to manifesting off-site: Rinsate will be removed from the tank and separater a§ the ririsirt�process is performed directlyinto the Nor(;CaloQil vaccum turck.. e. Rinsate Ilauler and permitted 'Treatment, Storage & Disposal Facility: Ilauler Name: Same as No. 6 Ilauler Registration N: Address: City: Zip: Phone No. Permitted Disposal Site: Refineries Services,Patterson, CA, or other approved facility. Page 4