Laserfiche WebLink
1. (a) Is the current certificate of worker's compensation insurance on file? YES NO[] <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? YE 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)& NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YES( NO[] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A Jry YES [ ] NO [ ] If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAX YES[ ] NO[ ] <br />5. Is there MI knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain YES [ ] NO <br />6. If tank residual exists, identify transporting hazardous waste hauler: NIA <br />Name Hauler Registration # <br />Address City Zip <br />Phone # <br />7. Decontamination Procedures: <br />a. Will tafirfsttmd piping be decontaminated prior to removal? YES [ ] NOX <br />b. Identify contractor performing decontamination: N ph // <br />Name /I T <br />Address City Zip <br />Phone No.( ) <br />C. Describe method to be used for decontamination: N `A" <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: NIA - <br />e. <br />fA- <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: N/A - <br />Hauler Name Hauler Registration # <br />Address City Zip <br />Phone No. ( ) <br />Permitted Disposal Site <br />8. a. Describe the method that will be utilized to purge and/or inert the tank(s): PL <br />b. Tank/Piping Hauler: I <br />Name " <br />Address City Zip <br />Phone No.( ) <br />Hauler Registration # (if hauled as hazardous) <br />EH 23 046 (Revised 8/1/11) 4 <br />