Laserfiche WebLink
r P � <br /> _ 0000132 <br /> I. a) Is there a PHS-EHD cixitnwtoor's yucstimnairc on file ou enclosed' YYES*Q NO[ I <br /> b) is the current certificate of worker's c(mnpcnsrtitxa insurance on file'! YES ] NO[ J <br /> C) Dues the contractor possess a "Hazardous Substance Removal Certification"? YES( ] NO( J <br /> 2. Has a "Site Health & Safety Plan" f4w this job site been submitted? YES DQ NO( ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[X] YES( J NO[ ] if YES.permit# <br /> 4. Has the contractor ohiained approval fnrtn die Irkal fire depumient to perform tank cutting <br /> NA(X] YES [ ) NO( ] <br /> S. Is there knowled,_e or evidence of leakage fn)m die tank(s)and/or piping? YES [ ] NO[ ] <br /> (If yes,please explain) Nn gee Anendir C <br /> 6. If tank residual exists,identify tr nspurting h:vankous waste hauler: <br /> Name ZMIC-KZ -S 1 NL Hauler Registration <br /> Address aS�+ 9! AAA_%LNb Cit��U+m,aU Zip <br /> Phone No.(S)O ) QM— 13 3 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping toe decontaminated prior to removal? YES[ ] NO <br /> b. Identify contractor performing de—contamination: <br /> Name <br /> Axys City Zip <br /> Phone No. ( ) <br /> c. Describe method to be used for decontamination: W1 <br /> i A <br /> d- Describe how rinsate material will be stored on-site prior to manifesting off-site: <br /> e. Rinsate Hauler and permitted Treaunent.Storage cL Disp isal Facility: <br /> Hauler Name �' A Hauler Registration # <br /> Address City Zip <br /> Phone No. I ) <br /> Permitted Disposal Site <br /> 4 <br />