Laserfiche WebLink
` 000082 <br /> 1. a) Is there a PHS-EHD contractor's questionnaire on file or enclosed? YESN' NO( J <br /> b) Is the current certificate of workers compensation insurance on file? YES)] NO( J <br /> c) Dins the contractor possess a "Hazardous Substance Removal Certification"? YES (�(j NO[ ] <br /> 2. Has a "Site Health & Safety Plan" for this job site been submitted? YES Al NO[ ] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A[X J YES [ J NO[ ] If YES. Pennit# <br /> 4. Has die contractor oh(ained approval fn►tn the local fire department to perform tank cutting) <br /> NA[X] YES [ ] NO[ ] <br /> 5. Is there knowled__e or evidence of leakage from the tank(s)and/or piping? YES [ ] NO[ ] <br /> (If yes,please explain) see Aa vdt x C <br /> 6. If tank residual exists.identify tnursporting hazardous waste hauler: <br /> Name ZMI 1V�5 ' NG Hauler Registration #00A <br /> Address City1cf4 t»nt'a Zip 94Z(3 <br /> Phone No. (SM <br /> 7. Decontamination Procedures: <br /> it. Will tank(s)and piping be decontauninatted prior to removal? YES [ ] NOV, <br /> b. Identify contractor perfonnina deconermination: <br /> Name <br /> Address City Zip <br /> Phone No. f ) <br /> c. Describe method to be used for decontamination:n: 14)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& Disposal Facility: <br /> Hauler Mune IV A Hauler Registration # <br /> Address City Zip <br /> Phone No. ) <br /> Permitted Disposal Site <br /> 4 <br />