COMPLIANCE INFO_1985-2003 - Laserfiche WebLink

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2. 3. 4. 5. (a) Is there a PHS•EHD contractor's and subcontractor's questionnaire on file or enclosed? YES [ NO [ ] (b) Is the current certificate of worker's compensation Insurance on f le? YES NO [ J (c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES WN0 [ j (d) Has everyone on site, including cranelbackhoe operator, been certified to work on hazardous waste site in accordance with CCR Title 8? YES VNO [ j Has a "Site Health & Safety Plan" for this job site been submitted? YES [4"NO [ J Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? NIA [toeYES[ ] NO [ ] If YES, Permit # Has the contractor obtained approval from the local fire department to perform tank cutting? NAdYES1 ] NO[ ] Is there knowledge or evidence of leakage from the s) and/or piping? Of yes, please explain) YES [ j NO [ If tank residual exists, identify transporting hazardous waste hauler. Name a - C _ t Address 2-55 Pi6%- Phone # ( 5 k0 ) 2 ;jS - Decontamination Procedures: :!4 `.\ : 111. . . a. Will tank(s) and piping be decontaminated prior to removal? YES [ ] NO b. Identify contractor performing decontamination: Name t 1 SD til S C5 tA�, < a7n c> tj , i G - Address 1 D j C ie --R City - i,; .Tt? PJ ti G A. zip : S 2 t -,- Phone No4 12_0� )� C. Describe method to be used for decontamination: W ,t L- Pv RGA D 00CE L I toe LJ I f 4 t TSO A �iy �P-a FPS Com. Li: -7i, !, r 9 (? f--- V4 t LL_ B + ®--t"1E 0 Y "o M P A,�_4 d. Describe how rinsate material will be stored onsite prior to manifesting offsite: ^-r M PtPr�C� SUMPS � zF=-i C_A k4iW . C(= 8Y e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility. Hauler Name . G® L .--Hauler Registration # Address �-y City Iktc� tino�.►Q, ��p Phone No.( Permitted Disposal Site° rfia `- EH 23 046 (Revised 08113199) Page 4