Laserfiche WebLink
E <br />E <br />1. (a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? <br />(b) Is the current certificate of worker's compensation insurance on file? <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? <br />(d) Has everyone on site, including crane/backhoe operator, been certified <br />to work on hazardous waste site in accordance with CCR Title 8? <br />YES I I NO I I <br />YES11 NO[] <br />YES X NO [ I <br />107p ,• <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES ( I NO I <br />3. Has applicant performing removal in the City of Tracy obtaided a "Grading and Excavation Permit"? <br />N/A g YES I I NO ( I If YES, Permit# <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA)4 YES(' NO( I <br />S. Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yei, please explain) YES NO <br />6. If tank residual exists, identify transporting hazardous waste hauler. <br />Name cri G Hauler Registration N <br />Address WIP I 4—fi-K-44 &e4A-- A4 - City JA6 t* _Zip— qlgfmisr <br />Phone # (qlto 1- 7�4- 2. 1 - <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES bd NO <br />b. Identify contractor performing decontamination: <br />Name <br />Address—'W#1 Yowl-lAotr GI&L11- City Zip <br />Phone No.( 41LO ) <br />C. Describe method to be used for decontamination: <br />Tr' Lo- 0-4*wsam. <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />e. Ringate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name 14gE 6ff V. Kr, i --,ect *%-c� 41*fricla- Hauler Registration # 3" 3 <br />J. <br />q* kft , <br />Address A tft&-jc- 4. city Stcrzip ls-rw <br />Phone No. q LW <br />Permitted Disposal Site <br />5/20 <br />EH 23 046 (Revised 9111/96) Page 4 <br />0 <br />