Laserfiche WebLink
n <br />1. (a) Is there a PHS -EB ctor's and lUbconavae1questionnalre on file or enclosed? YES K NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on file? YES M NO[] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES M NO[] <br />(d)' Has everyone on site, Including cranelbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES M NO[] <br />2. Hu a "Site Health & Safety Plan" for this job site been submitted? YES N NO ( j <br />3. Has applicant performing removal In the City of Tracy obtained a "Grading and Excavation Permit"? <br />NIA 4 YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAA] YES[ ] NO[ j <br />5. Is there knowledge or evidence of leakage from the s) and/or pi (If yes, please explain) YES [ ] NO,� <br />6. If tank residual exists, Identify transporting hazardous waste hauler: <br />NamE. C. Hauler <br />�.�rn HI' <br />M. .<a. 4 r <br />Phone #( 1(��� , <br />Decontamination Procedures. <br />a. will s) and piping be decontaminated prior to removal? YES [ ] NON <br />Identify contractor performing decontamination: <br />Address �11'1(o ... zip q� <br />c L v <br />.rrf: N04 X' <br />I: i',Qrtt r f. �:f r !o rr fr t,►rr <br />-Al <br />Describe i1` i:1: material1'r stored onalte prior to manifesting o <br />Hauler It :1 M I i. <br />,orf: No. csi <br />1r i Y I Y.1 f <br />EH a 046-(Sevised 10119198) Page 4 <br />