Laserfiche WebLink
I. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YES K NO [ ] <br />(b) Is the current certificate of worker's compensation insurance on file? YES 14 NO ( j <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES K NO [ j <br />(d) Has everyone on site, including cranetbackhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? YES KA NO ( ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted?x, 4� YES NO ( j <br />3. Has applicant performing removal in the City of�ned a "Grading and Excavation Permit"? <br />N/A K YES [ j NO [ J If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAN YES[ I NO[ ] <br />S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />Name EdJli.r 6u s.i .+�L 1//L"214&d:inHauler + Registration O <br />rs,AddressJ 1 A 41,mo � <br />Phone <br />7. DecontaminationProcedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES ( NO [ J <br />b. Identify contractor performing decontamination: <br />Name.�C.2 <br />AddressS 3 S - AJ✓1 . City —egv __ Zip$ - <br />Phone No.t oZ p ) 41 / (a 33 '"% <br />c.Describe rpethod to be use for decontamination: et,,-O-� —,u - L <br />` <br />,K. TS 0 +_ <br />d. D how rinsate at�per"^ial wi ' �s�torAdonsite pn to nifes 'ng offsit <br />.Cry l �G-Gc.c.t� <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal FaciIiry: <br />Hauler Name . Hauler Registration # D S/ $ <br />Address,©_- City IJ-AAtaA� Zip, 1�5� <br />Phone No. <br />Permitted Disposal Site p 'r 2o0 9 0.10 <br />C AT O $ 00133 "'-0 g o -2. 2- <br />EH 23 046 (Revised 9/11196) Page 4 <br />