Laserfiche WebLink
2. <br />3. <br />4. <br />5. <br />7 <br />8. a. <br />(a) Is the current certificate opworker's compensation insurance on file? • YES pQ NO [ ] <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? YES [)d NO [ ] <br />(c) Has everyone on site, including crane/backhoe operator, been certified to work on <br />hazardous waste sites in accordance with CCR Title 8? YES [A NO [ ] <br />Has a "Site Health & Safety Plan" for this job site been submitted? YES bd NO [ ] <br />Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A M YES I] NO [] If YES, Permit # <br />Has the contractor obtained approval from the local fire department to perform tank cutting? NAN YES[ ] NO[ ] <br />Is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ ] NO [ ] <br />NA <br />If tank residual exists, identify transporting hazardous waste hauler: <br />Name Clean Harbors Hauler Registration # <br />Address 1021 Berryessa Road City San Jose Zip 95133 <br />Phone # ( 408 ) 441-0962 <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES W NO[] <br />b. Identify contractor performing decontamination: <br />Name Elite IV Contractors <br />Address 2535 Wigwam Drive City Stockton Zip 95215 <br />Phone No.(209 ) 461-6337 <br />C. Describe method to be used for decontamination: <br />Rinse with cleaning agent (Simple Green) <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />DOT 55 gallons drums with hazardous waste labels <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: 3S,66 <br />Hauler Name Clean Harbors Hauler Registration # <br />Address 1021 Berryessa Road City San Jose Zip 95133 <br />Phone No. ( 408 ) 441-0962 <br />Permitted Disposal Site Disposal site to be determined based on the analytical results of rinseate <br />Describe the method that will be utilized to purge and/or inert the tank(s): <br />NONE - besides rinse with above method <br />Tank/Piping Hauler: <br />Name Clean Harbors <br />Address 1021 Berryessa Road City San Jose Zip 95133 <br />Phone No.( 408 ) 441-0962 <br />Hauler Registration # (if hauled as hazardous) -350b <br />EH 23 046 (Revised 8/1/11) 4 <br />