Laserfiche WebLink
1, (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed? YES NO [] <br /> (b) Is the current certificate of worker's compensation insurance on file? YE NO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification"? YES NO [] <br /> (d) Has everyone on site,including crane/backhoe operator,been certified to work on [J <br /> (e) hazardous waste site in accordance with CCR Title 8? YES NO <br /> 2. Has a"Site Health&Safety Plan!"for this job site been submitted? YESA NO [J <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A YES [] NO [I If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAO YES[] <br /> NO[J <br /> 5. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [] <br /> NO <br /> 4 <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name v Hauler/Registration# Z 14 <br /> Address :J 7 City L!l ' zip <br />[ Phone# .� <br /> a <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 ' d IJ� <br /> Address /may City Zip <br />� ,y J <br /> Phone No. � J P <br /> C. Describe method to beused for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> e. Rinsate Hauler and permitted Treatment, Storage &Disposal Facility: <br /> Hauler Registration <br /> Hauler Name # <br /> Address <br /> City Zip S / <br /> Phone No. (_ � 5f _ <br /> Permitted Disposal Site <br /> EH 23 046 (Revised 3/15/02) Page 4 <br /> 5 7 <br />